Early (1-3 years) signs of AD - short term memory deficits
disoriented to date
diminished recall of recent events
mild language and decision-making
... [Show More] deficits
mild problem copying figures (clock drawing)
social withdrawal
mood change
personality changes
problems with managing finances
Middle (2-8 years) stage of AD - disoriented to date and place
may get lost in familiar places
impaired learning new skills
agitation, aggression, restlessness, or anxiety
difficulty with ADLs such as cooking and grooming
Late (6-12 years) stage of AD - disoriented to person, time, or place
non-verbal
long term memory diminished
unable to groom or dress
progress to need for total care at end stage
incontinent
motor or verbal agitation
Alzheimer's disease (AD) demographic - most prevalent in people over age 65
African American (13.8%),
Hispanics (12.2%),
non-Hispanic whites (10.3%),
American Indian and Alaska Natives (9.1%),
Asian and Pacific Islanders (8.4%)
Genetics r/t AD - Genes appear to play a strong role, with late-onset AD showing heritability of 58-79% and early-onset AD showing over 90%
Neuroanatomy r/t AD - amyloid plaques and neurofibrillary tangles.
atrophy of hippocampus and cerebral cortex.
Neural Networks r/t AD - damage to synapses, mitochondrial abnormalities, and inflammatory processes
Neural Signaling r/t AD - decreased acetylcholinesterase activity and a permanent loss of cholinergic neurons
Acetylcholine (ACh) is a neurotransmitter necessary for processing memory and learning.
Diagnosis of AD - comprehensive health history is key to gather clues
Rule out other causes of dementia
Early AD may include anxiety, irritability, and sleep disruption
new-onset mental health symptoms in late 50s and 60s may be in the early stage of AD
Cholinesterase Inhibitors (ChEIs)X - do not change the progression of AD
provide some alleviation of symptoms
eg. donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, Razadyne ER),
donepezil (Aricept)
Mechanism of Action - inhibits centrally active acetylcholinesterase
donepezil (Aricept)
Common Side Effects - gastrointestinal symptoms (nausea and diarrhea)
headache
dizziness
muscle weakness
donepezil (Aricept)
Precaution - sick sinus syndrome
seizure disorder
donepezil (Aricept)
Prescribing Pearls - Taper to avoid withdrawal effects.
Donepezil (Aricept) is approved to treat moderate to severe AD at 23 mg/day dose, but there is minimal improvement in cognitive functioning when compared to a 10 mg/day dose. At the higher dose, donepezil has a higher incidence of adverse [Show Less]