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  • Image not available. Alzheimer's disease (AD) is the most common form of dementing illness, and the prevalence of AD increases with each decade of life.
  • Image not available. The etiology of AD is unknown, and current pharmacotherapy neither cures nor arrests the pathophysiology.
  • Image not available.Neuritic plaques and neurofibrillary tangles are the pathologic hallmarks of AD; however, the definitive cause of this disease is yet to be determined.
  • Image not available. AD affects multiple areas of cognition and is characterized by a gradual onset with a slow, progressive decline.
  • Image not available. A thorough physical examination (including neurologic examination), as well as laboratory and imaging studies, is required to rule out other disorders and diagnose AD before considering drug therapy.
  • Image not available. Pharmacotherapy for AD focuses on impacting three domains: cognition, behavioral and psychiatric symptoms, and functional ability.
  • Image not available. Nondrug therapy and social support for the patient and family are the primary treatment interventions for AD.
  • Image not available. Cholinesterase inhibitors and memantine are used to treat cognitive symptoms of AD; other medications have been suggested to be beneficial because of their potential preventive or cognitive effects.
  • Image not available. Appropriate management of vascular disease risk factors may reduce the risk for developing AD and may prevent the worsening of dementia in patients with AD.
  • Image not available. A thorough behavioral assessment and plan with careful examination of environmental factors should be conducted before initiating drug therapy for behavioral symptoms.
  • Image not available. Pharmacotherapy may reduce the total cost of treating AD by delaying cognitive decline and time to nursing home placement.

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Upon completion of the chapter, the reader will be able to:

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  • 1. List the most common types of dementia in late life.
  • 2. Distinguish between early-onset and late-onset Alzheimer’s disease (AD).
  • 3. Discuss genetic and environmental causes that can play a role in the etiology of AD.
  • 4. Identify the hallmark pathophysiologic lesions in AD.
  • 5. Identify the neurotransmitter systems affected by AD.
  • 6. Discuss the importance of brain vascular health in AD.
  • 7. Describe the signs and symptoms of various stages of AD.
  • 8. Discuss the diagnostic criteria for AD.
  • 9. Explain the primary treatment goals of both pharmacologic and nonpharmacologic therapies for AD.
  • 10. Describe the general approach to developing nonpharmacologic strategies for managing behavioral symptoms in patients with AD.
  • 11. Discuss the mechanism of action, dosing, administration, and side-effect profiles of the available cholinesterase inhibitors.
  • 12. Discuss the mechanism of action, dosing, administration, and side-effect profile of memantine.
  • 13. Discuss the advantages and disadvantages of estrogen, antiinflammatory agents, lipid-lowering agents, and dietary supplements (vitamin E, Ginkgo biloba, huperzine A, omega-3 fatty acid, and medical foods) as treatments for patients with AD.
  • 14. Develop a treatment and monitoring plan for cognitive symptoms in a patient newly diagnosed with mild AD.
  • 15. List available treatment options and recommended dosages for behavioral symptoms of AD.
  • 16. Explain the risks associated with antipsychotic use in patients with AD.
  • 17. Evaluate the economic impact of AD.

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