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SOURCE

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Source: Peron EP, Slattum PW, Powers KE, Hobgood SE. Alzheimer disease. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146062470. Accessed January 20, 2017.

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DEFINITION

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  • Progressive dementia leading to loss of cognitive, analytical, and physical functioning.

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ETIOLOGY

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  • Exact etiology unknown.

  • Potential causes include:

    • Genetic factors.

    • Environmental factors.

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PATHOPHYSIOLOGY

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  • Exact pathophysiology of Alzheimer disease (AD) not entirely known, and no cure exists.

  • Intracellular neurofibrillary tangles, extracellular neuritic plaques, degeneration of neurons and synapses, cortical atrophy.

  • β-Amyloid protein aggregation leading to plaque formation, hyperphosphorylation of tau protein, inflammatory processes, vasculature injury, depletion of neurotrophin and neurotransmitters.

  • Loss of cholinergic activity and serotonergic neurons.

  • Increased activity of monoamine oxidase type B

  • Abnormal glutamate pathways of cortex and limbic structures.

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EPIDEMIOLOGY

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  • Affects approximately 5.3 million Americans.

  • Number of AD patients is projected to be 13.8 million by 2050.

  • Most cases present in persons over age 65 years, but 4% occur in younger persons.

  • AD is the fifth leading cause of death in persons age 65 years and older in the United States.

  • Most common form of dementing illness, and the prevalence of AD increases with each decade of life.

  • AD accounts for 60% of cases in persons over the age of 65 years.

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RISK FACTORS

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  • Hypertension.

  • Increasing age.

  • Elevated LDL cholesterol.

  • Low HDL cholesterol.

  • Diabetes mellitus.

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CLINICAL PRESENTATION

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SYMPTOMS
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  • Cognitive.

    • Memory loss (poor recall and losing items)

    • Aphasia (circumlocution and anomia)

    • Apraxia.

    • Agnosia.

    • Disorientation (impaired perception of time and unable to recognize familiar people)

    • Impaired executive function.

  • Noncognitive (behavioral)

    • Depression.

    • Psychotic symptoms (hallucinations/delusions)

    • Behavioral disturbances (aggression, hyperactivity, uncooperativeness, wandering, repetitive mannerisms, combativeness)

  • Functional.

    • Inability to care for self.

      • Instrumental activities of daily living.

        • Handling finances and organizing medications.

      • Activities of daily living (ADL)

        • Hygiene and dressing.

  • Stages.

    • Mild (Mini-Mental Status Examination [MMSE] score 26–21):

      • Difficulty remembering recent events.

      • Declining ability to manage finances, prepare food, and perform other household activities.

      • May get lost while driving.

      • Begin to withdraw from difficult tasks and give up hobbies.

      • May deny memory problems.

    • Moderate (MMSE score 20–10):

      • Requires assistance with ADLs.

      • Frequently disoriented to time. Severely impaired recall for recent events.

      • May forget details of past life and names of family and friends.

      • Functioning may fluctuate.

      • Loses ability to drive safely.

      • Generally denies problems.

      • May become suspicious or tearful. Agitation, paranoia, and delusions are common.

    • Severe (MMSE score 9–0):

      • Loses ability to speak, walk, and feed self.

      • Incontinent of urine and feces.

      • Requires care 24 hours per day, 7 days a week.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • History and physical examination with neurologic ...

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