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    Alzheimers Disease

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    charmingsouji.akkineni

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    Alzheimers Disease

    Uploaded by

    charmingsouji.akkineni
    1 views15 pages

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    alzheimers disease

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    1 views15 pages

    Alzheimers Disease

    Uploaded by

    charmingsouji.akkineni

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 15

    ALZHEIMERS DISEASE

    BY-
    DR.A.SOUJANYA,PHARM.D
    DEFINITION

    Progressive and eventually total


    dementia(loss of memory) of
    unknown cause characterised by
    loss of cognitive(trouble
    concentrating,making
    decisions,poor memory) & physical
    functioning,commonly with
    behavioural symptoms
    STAGES-
    Pt has difficulty remembering
    MILD(MMS recent events. ability to manage
    E score: finances, prepare food &
    26-18) carryout other household
    activities decline
    Pt requires assistance with daily
    MODERATE activities.frequently disoriented with
    (MMSE regard to time. recall for recent
    score: 17- events is severely impaired. may
    10) become suspicious or fearful.
    paranoia,agitation,delusions are
    common
    Pt loses ability to speak,walk & feed
    SEVERE(MM self. urinary & feces incontinence.
    PATHOPHYSIOLOGY
    Young onset-rare. Dominantly
    inherited forms attributed to
    alterations in chromosome 1,14,21
    Late onset-linked to apolipoprotein E
    (APPE)
    Genotype & interaction of multiple
    genes wit environment
    Signature findings/changes seen in
    brain-
    1.Intracellular neurofibrillary
    tangles(NFT).Density of NFT
    2. Extracellular amyloid plaques in
    cortex & medial temporal lobe
    3.Degenration of neurons,synapses &
    cortical atrophy

    Proposed mechanisms for the


    changes-
    1.Beta amyoid protein aggregation
    formation of plaques
    2.Hyperphosphorylation of tau protein
    NFT’S,synaptic failure, depletion of
    neurotropin
    3.Mitochondial dysfunction
    4.Oxidative stress

    5.Cholinergic cell loss


    6.Loss of serotonergic neurons of
    raphe nuclei & noradrenergic cells of
    locus ceruleus
    7.MAO-B activity increases
    8.Glutamate pathways(excitatory
    neurotransmitters) of the cortex &
    limbic structure are abnormal &
    RISK FACTORS-
    Age
    Head injury
    Down syndrome
    Depression
    Mild cognitive impairment
    Hypertension
    Inc. LDL-C
    Dec HDL-C
    Diabetes mellitus
    SYMPTOMS-
    Cognitive decline(trouble
    concentrating,poor memory,poor
    decision making)
    Aphasia-
    Aproxia
    Agnosia
    Disorientation
    Impaired executive function(Cannot
    take self care,cannot perform daily
    activities)

    Urinary & feces incontinence
    Sleep disturbances
    Psychotic
    symptoms(delusions,paranoia)
    Agitation
    Motor hyperactivity
    Wandering
    DIAGNOSIS
    Past medical,medication,personal &
    family history
    Physical examination
    Lab tests- Serum B12,folate,thyroid
    panel,blood cell count)
    Cerebrospinal fluid analysis
    Electroencephalogram
    CT,MRI
    Folestein mini-mental state
    examination(MMSE)
    TREATMENT
    GOAL-
    Maintain functioning as long as
    possible.
    NON PHARMACOLOGICAL-
    Behavioural & environmental
    interventions
    Preventive therapy-vitamin E,low
    PHARMACOTHERAPY OF COGNITIVE
    dose aspirin in patients with brain
    SYMPTOMS
    vascular disease
    1.choline esterase inhibitors-
    Drug Bran Initi Maintanen ADR Comment Indicatio
    name d al ce dose s ns
    name dose
    Donepezil Aricep 5mg 5-10mg- Dizziness,sy Take with Mild,mod
    t ODT in mild to ncope,brad or without erate &
    eveni moderate ycardia,atri food,orally severe AD
    ng 10-23mg- al disintegrat
    moderate to arrythmia,M ing tablet
    severe I,angina,sei
    zure,
    SA & AV
    block

    rivastigmi Exelo 1.5m 3-6mg Nausea,vo With Mild to


    ne n g(ora BD(oral) miting,diarr food,capsu moderate
    l) BD hea,anorexi le,oral AD
    4.6m 9.5- a,weightlos solution,tr
    g/ 13.3mg/ s ansdermal
    day(p day(patch) patch
    atch)
    Galantami Razad 4mg 8-12mg Insomnia,ni With Mild to
    ne yne BD(ta BD(tablet) ghtmares,P food,tablet moderate
    blet) UD,GI ,oral AD
    8mg 16- bleeding solution,ex
    in 24mg(exten tended
    2.N-methyl-D-aspartate(NMDA)
    Antagonist-
    Drug Brand Initi Maintanen ADR Comment indicatio
    name name al ce dose s ns
    dose
    Memanti Namen 5mg 10mg BD Constipati With or Moderate
    ne da 7mg( 28mg daily on,heada without to severe
    XR) che,confu food,availa AD
    sion,dizzi ble as
    ness,hallu tablet,oral
    cinations, solution,ex
    GI tended
    distress release

    PHARMACOTHERAPY OF NON
    COGNITIVE SYMPTOMS
    DRUGS INITIAL MAINTANENCE TARGET SYMPTOMS
    DOSE(mg DOSE(mg)
    )
    ANTIPSYCHOTICS Psychosis:
    hallucinations,delusions,s
    aripiprazole 10-15 30(max)
    uspiciousness,
    olanzapine 2.5 5-10 disruptive behaviours:
    quetiapine 25 100-400 agitation,aggression

    risperidone 0.25 0.5-2


    ANTIDEPRESSANT
    S
    Citalopram 10 10-20 Depression: poor
    appetite,insomnia,hopeles
    escitalopram 5 10(max) sness,anhedonia,withdraw
    fluoxetine 10 10-20 al,suicidal
    thoughts,agigation,anxiet
    paroxetine 10 10-40 y
    sertraline 12.5 150(max)
    mirtazapine 15 15-30
    trazodone 25 75-150
    ANTICONVULSANT
    S Agitation,aggression

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