Alzheimer Disease Flashcards
(15 cards)
How is Alzheimer’s Disease characterized?
A progressive neurodegenerative disorder characterized by:
- Cognitive decline: Including memory loss, disorientation, impaired judgment and learning.
- Diagnosed primarily by excluding other causes of dementia.
- No single unique symptom; requires thorough patient history.
- No cure; treatments aim to slow symptom progression.
What are the main neuropathological hallmarks of AD, and which neurotransmitter is primarily affected?
- Neurofibrillary Tangles: Intracellular accumulations of hyperphosphorylated Tau protein.
- Neuritic (Amyloid) Plaques: Extracellular deposits of Amyloid-beta protein.
- Leads to neuronal loss and dysfunction, particularly cholinergic neurons (deficiency in Acetylcholine - Ach), causing learning/memory impairment.
- Other factors: Neuroinflammation, mitochondrial dysfunction, autophagy dysfunction, Lewy body deposition (overlap).
Which brain regions are primarily affected in AD, correlating with symptoms?
Regions involved in learning, memory, and emotional behavior:
- Cerebral cortex
- Hippocampus
- Basal forebrain
- Amygdala
List some common early signs of AD.
- Memory loss (especially recent events)
- Difficulty completing familiar tasks
- Confusion with time or place
- Trouble understanding visual images/spatial relationships
- Problems with words (speaking/writing)
- Misplacing things / inability to retrace steps
- Decreased/poor judgment
- Withdrawal from work/social activities
- Changes in mood/personality
Briefly describe the typical progression through AD stages.
- Mild: Minor memory loss, difficulty learning new info, may be aware & hide decline (lasts 2-4 yrs).
- Moderate: Increased confusion, difficulty with self-care, behavioral changes (anger, anxiety), needs caregiver assistance (lasts 2-10 yrs).
- Severe: Completely incapacitated, loss of bodily functions, difficulty speaking/recognizing people, often requires total care (lasts 1-3 yrs).
(Progression varies significantly)
What are the primary and secondary goals of AD treatment?
- Primary Goal: Delay disease progression and preserve functioning for as long as possible.
- Secondary Goal: Treat psychiatric and behavioral symptoms (BPSD) that occur.
What are the two main classes of drugs used for symptomatic treatment of cognitive decline in AD?
- Cholinesterase Inhibitors (ChEIs): Increase acetylcholine levels by inhibiting its breakdown. (Used for mild-moderate AD).
- NMDA Receptor Antagonists: Modulate glutamate activity, protecting against excitotoxicity. (Used for moderate-severe AD).
List common ChEIs used in AD and their general MOA.
Donepezil (Aricept): Reversible AChE inhibitor. Approved for all stages.
Rivastigmine (Exelon): Inhibits both AChE and BuChE. Available as capsule and patch. (Mild-moderate, patch also for severe).
Galantamine (Razadyne): Inhibits AChE and modulates nicotinic receptors. (Mild-moderate).
MOA: Increase synaptic acetylcholine levels.
Common ADRs: N/V/D, muscle cramps, fatigue, weight loss, insomnia.
Name the primary NMDA antagonist used in AD and its MOA.
- Memantine (Namenda):
- MOA: Non-competitive antagonist of the NMDA receptor. Blocks toxic effects of excess glutamate and regulates glutamate activation.
- Used for moderate-to-severe AD (can be combined with ChEIs - e.g., Namzaric).
- Common ADRs: Dizziness, headache, constipation, confusion.
Which antidepressants are preferred for depression in AD, and which should be avoided?
- Preferred: Selective Serotonin Reuptake Inhibitors (SSRIs) like Sertraline, Citalopram, Escitalopram. (Fewer anticholinergic effects).
- Avoid: Tricyclic Antidepressants (TCAs) like Amitriptyline due to strong anticholinergic effects that worsen cognition.
Which antipsychotics are sometimes used for severe aggression/psychosis in AD? What is the major warning? Which class to avoid?
- Used with Caution: Atypical antipsychotics like Risperidone (best studied), Olanzapine, Quetiapine (at low doses).
- Warning: Increased risk of stroke and mortality in elderly dementia patients (Black Box Warning).
- Avoid: Typical antipsychotics (e.g., Haloperidol) unless absolutely necessary due to higher risk of Extrapyramidal Symptoms (EPS).
Which anxiolytic is preferred for anxiety/agitation in AD? Which class is generally avoided?
- Preferred: Buspirone.
- Avoid: Benzodiazepines (e.g., Lorazepam, Diazepam) due to increased fall risk, sedation, and worsening cognition.
What agents can be used for insomnia in AD? Which drugs should generally be avoided?
- Consider: Melatonin, low-dose Trazodone, Mirtazapine (also helps appetite).
- Avoid: Long-acting benzodiazepines, sedating antihistamines (e.g., diphenhydramine) due to anticholinergic effects and next-day sedation.
What is the target of newer disease-modifying therapies for AD (e.g., Lecanemab)? What is a key side effect concern?
- Target: Anti-Amyloid Monoclonal Antibodies aim to clear amyloid plaques to slow disease progression.
- Indication: Early-stage AD.
- Key Side Effect: ARIA (Amyloid-Related Imaging Abnormalities) - includes brain swelling (edema) or microhemorrhages, requires MRI monitoring.
List some non-pharmacologic approaches for managing AD patients.
- Gentle, calm approach
- Reassurance, empathy
- Distraction and redirection
- Maintain routines
- Safe environment
- Daytime activities
- Familiar items
- Behavioral interventions (music, light exercise, sensory stimulation)
- Caregiver support and education
