Alzheimer's Disease

Question 1

What are some clinical features of dementia?

Answer 1

Episodic memory, language function, frontal executive function, apraxia, agnosia.

Question 2

What are some of the etiologies of dementia?

Answer 2

Hypothyroidism, Alzheimers disease, vitamin B12 deficiency, HIV infections, psychiatric.

Question 3

Whats the main characterization of AD?

Answer 3

Amyloid plaques and neurofibrilliary tangles in corticol areas and medial temporal lobe structures. These damage the synapse and cause neuronal death.

Question 4

What consequence do the neurofibrillary tangles bring?

Answer 4

Composed of expessively hyperphosphorylated tau protein and abnormal phosphorylation causes cell death

Question 5

What are the inflammatory and the cholinergic hypotheses?

Answer 5

Amyloid plaque formation is associated with local inflammatory and immune changes.
And loss of neuronal pathways lead to many neurotransmitter abnormalities and a loss of cholinergic activity is pronounced.

Question 6

What are other neurotransmitter abnormalities?

Answer 6

5HT, NA (loss of neurons). Increase in glutamate activity.

Question 7

What are the stages of alzheimer’s disease?

Answer 7

Mild- disorientated with regard to time
Moderate - recall of recent events is severely impaired
Severe - unable to speak, incontinent

Question 8

What is the primary goal of treatment?

Answer 8

Increase acetylcholine and reduce glutamate (NMDA-receptor activity)

Question 9

What are drug examples?

Answer 9

Cholinesterase inhibitors - donepezil, rivastigmine, galantamine
NMDA- receptor antagonists (memantine)

Question 10

What are the differences between the agents?

Answer 10

Donepezil - selective AChE inhibitor
Rivastigmine - Inhibits both AchE and BuCHE
Galantamine - Selectively inhibits AChE and increases ACh activity of the nicotinic receptors.

Question 11

What are the most common adverse effects?

Answer 11

Nausea, vomiting, agitation, muscle cramps, hallucinations

Question 12

What are two important treatment recommendations?

Answer 12

Switch from one cholinesterase inhibitor to another if switch is due to side effect intolerability (washout period is needed) 1 week
Switch overnight if due to lack of initial benefit.

Question 13

What are some adverse effects of memantine?

Answer 13

Constipation, dizziness, confusion, headache, hypertension.