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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 53, Alzheimer Disease.

KEY CONCEPTS

KEY CONCEPTS

  • imageAlzheimer disease (AD) is the most common form of dementing illness, and the prevalence of AD increases with each decade of life.

  • imageThe etiology of AD is unknown, and current pharmacotherapy neither cures nor arrests the pathophysiology.

  • imageAmyloid plaques and neurofibrillary tangles (NFTs) are the pathologic hallmarks of AD; however, the definitive cause of this disease is yet to be determined.

  • imageAlzheimer disease affects multiple areas of cognition and is characterized by a gradual onset with a slow, progressive decline.

  • imageA 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.

  • imagePharmacotherapy for AD focuses on impacting three domains: (1) cognition, (2) neuropsychiatric symptoms, and (3) functional ability.

  • imageNondrug therapy and social support for the patient and family are the primary treatment interventions for AD.

  • imageCholinesterase 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.

  • imageAppropriate management of vascular disease risk factors may reduce the risk for developing AD and may prevent the worsening of dementia in people with AD.

  • imageA thorough behavioral assessment and plan with careful examination of environmental factors should be conducted before initiating drug therapy for behavioral symptoms.

PATIENT CARE PROCESS

Patient Care Process for Alzheimer Disease

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Collect

  • Patient characteristics (eg, age, sex)

  • Patient history (eg, past medical, family, social history)

  • Current medications including medications that may cause or worsen cognitive, neuropsychiatric, and/or functional symptoms (see list of common offending agents, in “Assess”)

  • Assessments for cognitive, neuropsychiatric and functional symptoms; for example:

    • Mini-Mental State Examination (cognition)

    • Neuropsychiatric Inventory (behavioral disturbances)

    • Bristol Activities of Daily Living Scale (function)

  • Laboratory data

    • Comprehensive metabolic panel, including electrolytes, glucose, and liver function tests

    • Complete blood cell count, serum B12, and thyroid function tests

    • Rapid plasma reagin and human immunodeficiency virus testing

Assess

  • Risk factors for Alzheimer disease (eg, age, family history, low education level, smoking)

  • Cognitive symptoms (eg, memory loss, aphasia, apraxia, agnosia, disorientation, impaired executive function)

  • Neuropsychiatric symptoms (eg, depression, psychotic symptoms, behavioral disturbances)

  • Functional symptoms (eg, inability to care for self), including patient’s ability to manage and self-administer their own medications

  • Medications that may cause or worsen cognitive, neuropsychiatric, and/or functional symptoms; for example:

    • Benzodiazepines and other sedative hypnotics

    • Anticholinergics

    • Opioid analgesics

    • Antipsychotics

    • Anticonvulsants

    • Skeletal muscle relaxants

  • Diseases or syndromes that may cause or worsen cognitive, neuropsychiatric, and/or functional symptoms; for example:

    • Alcohol or drug abuse

    • Depression

    • B12 or folate deficiency

    • Hypothyroidism

    • Electrolyte disturbances (eg, hyponatremia)

    • Glucose abnormalities (eg, hypoglycemia)

    • Infectious processes (eg, tertiary syphilis)

    • Vision, hearing, or other sensory impairments

    • Other common types of dementia in ...

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