PW, Swerdlow RH, Massey Hill A. Alzheimer’s
Disease. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells
BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://www.accesspharmacy.com/content.aspx?aid=7984697.
Accessed May 25, 2012.
- Progressive dementia leading to loss of cognitive, analytical,
and physical functioning
- 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.
- Affects approximately 5.3 million Americans.
- Number of patients is projected to be 13.2 million by 2050.
- Most cases present in persons over age 65 years, but 5% occur
in younger persons.
- Elevated LDL cholesterol
- Low HDL cholesterol
- Diabetes mellitus
- Memory loss
- Impaired executive function
- Behavioral disturbances (aggression, hyperactivity, uncooperativeness,
- Functional: Inability to care for self
- Mild (Mini-Mental Status Examination [MMSE] score
- Difficulty remembering recent events
- Declining ability to manage finances, prepare food, and perform
other household activities
- May get lost while driving.
- Begins to withdraw from difficult tasks and give up hobbies.
- May deny memory problems.
- Moderate (MMSE score 17–10):
assistance with activities of daily living (ADLs).
- Frequently disoriented to time. Severely impaired recall for recent
- 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 constant care.
Means of Confirmation
- History and physical examination with neurologic and psychiatric
exams, standardized rating assessments, functional evaluation, caregiver
- Information about prescription drug use; alcohol/substance
use; history of trauma, depression, or head injury
- Rule out medication use as contributor to symptoms (anticholinergics,
sedatives, hypnotics, opioids, antipsychotics, anticonvulsants).
- Folstein MMSE to help establish history of
deficits in two or more areas of cognition and establish a baseline
- Vitamin B12 and folate levels to rule out deficiency
- Thyroid function tests to rule out hypothyroidism
- Complete blood count, serum electrolytes, liver function tests
- CT or MRI scans may aid diagnosis.
- Maintain functioning as long as possible.
- Treat psychiatric and behavioral sequelae.
- Managing blood pressure, cholesterol, and blood glucose
may prevent worsening dementia.
- Pharmacotherapy is symptomatic to improve or maintain cognition.
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