Dementia / Alzheimer's Disease

Front 1

What are the manifestations of alzheimer's disease?

Back 1

loss of cognitive function, memory deterioration, impairment in activities of daily living, neuropsychiatric symptoms, behavior issues

Front 2

Define dementia

Back 2

Any 2:
-difficulties learning/retaining new information
-impairment in completing complex tasks and reasoning abilities
-impairment in visuspatial function and geographic orientation
-language difficulties

Front 3

What does impairment in episodic declarative memory mean?

Back 3

difficulties in learning/retaining new information

Front 4

What does impairment in executive cognitive functions mean?

Back 4

impairment in completing complex tasks and reasoning abilities

Front 5

What is the pathophysiology in AD?

Back 5

senile plaques (beta amyloid and amyloid precursor protein) and neurotibrillary tangles (tau)

Front 6

What is the cholinergic hypothesis of AD?

Back 6

cognitive deterioration due to loss of cns acetylcholine

Front 7

What are the epidemiologic risk factors for AD?

Back 7

age, female sex, head trauma, midlife hypertension, stroke, small head circumference

Front 8

What are the genetic risk factors for AD?

Back 8

ApoE-e4 genotype, SORL1 genotype, family hx of dementia

Front 9

What are the physiologic risk factors for AD?

Back 9

hypothyroidism, high cholesterol, diabetes, low diastolic BP, increased homocysteine levels

Front 10

Secondary causes of dementia?

Back 10

CNS drugs, systemic metabolic disorders, endocrine disorders, neoplasms, subdural hematomas, normal pressure hydrocephalus, meningitis

Front 11

What are the causes of primary dementias?

Back 11

alzheimers, vascular dementia, dementia with lewy bodies, frontotemporal lobar degenerations, Creutzfeldt Jakob disease

Front 12

What are the s/sx of Creutzfeldt Jakob disease?

Back 12

rapid onset, neurological signs, abnormal CSF or MR

Front 13

What are the s/sx of frontotemporal lobar degeneration?

Back 13

aphasia or disorder of behavior, comportment or executive function

Front 14

What are the s/sx of dementia with lewy bodies?

Back 14

extrapyramadial signs, hallucinations, sleep disorders

Front 15

What are the s/sx of vascular dementia?

Back 15

cognitive impairment related to stroke or infarcts on imaging

Front 16

Core diagnostic features that are included in episodic memory impairment of AD pts early on?

Back 16

-memory loss over more than 6 months
-significantly impaired episodic memory on objective testing

Front 17

Supportive diag features in AD?

Back 17

-medial temporal lobe atrophy
-CSF biomarker
-PET imaging
-AD genotyping (autosomal dominant) in immediate family member

Front 18

Drugs that can impair cognitive function in AD pts?

Back 18

BAAMC - barbiturates, anticholinergics, antispasmodics, muscle relaxants, cns stimulants

Front 19

antidepressant anticholinergic to avoid in AD pts?

Back 19

amitriptylline

Front 20

antiarrhytmic anticholinergic to avoid in AD pts?

Back 20

quinidine, disopyramide

Front 21

antiemetic anticholinergic to avoid in AD pts?

Back 21

diphenhydrinate, meclizine, promethazine

Front 22

typical and atypical antipsychotics anticholinergic to avoid in AD pts?

Back 22

chlopromazine, clozapine, olazapine, quetiapine

Front 23

bronchodilators anticholinergic to avoid in AD pts?

Back 23

ipratropium

Front 24

gi antispasmotics anticholinergic to avoid in AD pts?

Back 24

hyoscyamine

Front 25

mydiatics/cycloplegics anticholinergic to avoid in AD pts?

Back 25

atropine, cyclopentolate

Front 26

overactive bladder rx anticholinergic to avoid in AD pts?

Back 26

oxybutynin

Front 27

parkinson's rx anticholinergic to avoid in AD pts?

Back 27

bentropine

Front 28

skeletal muscle relaxant anticholinergic to avoid in AD pts?

Back 28

cyclobenzaprine

Front 29

Tx goal in AD?

Back 29

-temporarily improve, stabilize or slow the decline of cognitive functional, and behavioral symptoms
-reduce caregiver burden and delay nursing home placement

Front 30

MOA of donepezil (aricept)?

Back 30

selective ach inhibitor

Front 31

moa of galantamine?

Back 31

selective ach'ase inhibitor and nicotinic receptor modulator

Front 32

trade name for galantamine?

Back 32

Razadyne

Front 33

moa of rivastigmine?

Back 33

dual ach'ase and butyrylcholinesterase inhibitor

Front 34

trade name of rivastigmine?

Back 34

exelon

Front 35

Clinical benefits of cholinesterase inhibitors?

Back 35

improved or delayed decline in cognition, preserved functional ability, improved disturbed behaviors, reduce caregiver burden, delayed nursing home placement

Front 36

SEs of donepezil?

Back 36

N/V, diarrhea, anorexia, insomnia, muscle cramps, fatigue, syncope

Front 37

SEs of rivastigmine?

Back 37

N/V, anorexia, weight loss, dyspepsia, asthenia, dizziness, fatigue, diarrhea

Front 38

SEs of galantamine?

Back 38

N/V, anorexia, weight loss, syncope, fatigue, dizziness, dyspepsia, diarrhea

Front 39

MOA of memantine?

Back 39

non-competitive n-methyl-D-aspartate (NMDA) antagonist

Front 40

What is the trade name for memantine?

Back 40

namenda

Front 41

Clinical benefits of memantine?

Back 41

memantine added to donepezil in moderate to severe AD resulted in significantly better outcomes than donepezil plus placebo over 6 months

Front 42

adverse effects of memantine?

Back 42

confusion, somnolence, falls, HA

Front 43

initial dose for donepezil?

Back 43

5mg/day

Front 44

target dose for donepezil?

Back 44

10mg/day

Front 45

initial dose for galantamine?

Back 45

8mg/day

Front 46

target dose for galantamine?

Back 46

16-24mg/day

Front 47

initial dose for rivastigmine?

Back 47

3mg/day

Front 48

target dose for rivastigmine?

Back 48

6-12mg/day

Front 49

initial dose for memantine?

Back 49

5mg/day

Front 50

target dose for memantine?

Back 50

20mg/day

Front 51

CYP metabolism for donepezil

Back 51

2d6 & 3a4

Front 52

CYP metabolism for galantamine?

Back 52

2d6 & 3a4

Front 53

CYP metabolism for rivastigmine?

Back 53

no

Front 54

CYP metabolism for memantine?

Back 54

no

Front 55

doses per day for donepezil?

Back 55

one

Front 56

doses per day for galantamine?

Back 56

two (imm), one (ER)

Front 57

doses per day for rivastigmine?

Back 57

two

Front 58

doses per day for memantine?

Back 58

two (1st wk is one/d)

Front 59

time to change dose for donepezil?

Back 59

q 4-6wks

Front 60

time to change dose for galantamine?

Back 60

q4 wks to target dose or SEs

Front 61

time to change dose for rivastigmine?

Back 61

q 2 wks to target or SEs

Front 62

time to change dose for memantine?

Back 62

q wk to target or SEs

Front 63

Therapy for use in vascular dementia?

Back 63

possibly cholinesterase inhibitors or memantine. Importance is to get early tx of HTN and vascular disease

Front 64

Therapy for use in dementia with lewy bodies?

Back 64

cholinesterase inhibitors in mild-to-moderate disease

Front 65

Therapy for use in dementia of parkinson's disease?

Back 65

cholinesterase inhibiotrs (only to use rivastigmine) in mild-to-moderate

Front 66

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Back 66

EAF

Front 67

Treatment failure washout period length?

Back 67

no washout period

Front 68

AEs to donepezil washout period?

Back 68

1-2 wks

Front 69

AEs to rivastigmine or galantamine washout period?

Back 69

1 day

Front 70

MOA of secretase modulators?

Back 70

decrease beta amyloid production

Front 71

name of secretase modulator discussed?

Back 71

bryostatin-1

Front 72

name of vaccine for beta amyloid?

Back 72

vaccine AN1792

Front 73

name of beta amyloid fibrilization inhibitors?

Back 73

NC-531 (alzhemed), PBT-1 (Clioquinol), PBT-2

Front 74

name of anti-tau medications?

Back 74

CDK5, GSK-3B

Front 75

Purpose of mini-mental exam?

Back 75

measures cognition

Front 76

what does the mini-mental assess?

Back 76

orientation, registration, recall, language, and attention (for medical personel to use)

Front 77

On average, how much does the mini-mental score decrease per year in pts with AD?

Back 77

2-4 pts

Front 78

what is the purpose of the function activities questionnaire?

Back 78

intended to quantify level of disability (for caregivers to use)

Front 79

what is the purpose of the neuropsychiatric inventory?

Back 79

measures disturbed behaviors

Front 80

what does neuropsychiatric inventory assess?

Back 80

frequency and severity of 12 symptoms (agitation, irritability, depression, hallucinations, etc)

Front 81

MMSE score of 30?

Back 81

no dementia

Front 82

MMSE score of 26-29?

Back 82

questionable dementia

Front 83

MMSE score of 21-25?

Back 83

mild dementia

Front 84

MMSE score of 11-20?

Back 84

moderate dementia?

Front 85

MMSE of 0-10?

Back 85

severe dementia