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KEY CONCEPTS

KEY CONCEPTS

  • imageAlzheimer disease (AD) is the most common cause of dementia, the prevalence of which increases with each decade of life.

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

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

  • imageA thorough physical examination (including a neurologic examination), as well as laboratory and imaging studies, are required to rule out other disorders and diagnose AD before considering pharmacotherapy.

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

  • imageNonmedication 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; whereas immunotherapies may have the potential to be disease-modifying.

  • imageAducanumab, an amyloid beta-directed antibody, was Food and Drug Administration (FDA) approved in 2021 for AD via accelerated approval. Donanemab was granted breakthrough therapy designation and is continuing to be evaluated.

  • 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 with careful examination of environmental factors should be conducted, and a plan put in place before initiating medication therapy for behavioral symptoms.

BEYOND THE BOOK

BEYOND THE BOOK

Visit the Mini-Cog website at http://mini-cog.com. At the top of the screen select from the “Mini-Cog Versions” drop-down menu the “Standardized Mini-Cog Instrument” tab:

  1. Review the three-step process and scoring guidelines. You do not need to print this document, as you can simply draw a circle on a blank piece of paper for your partner to use while you take notes on a separate piece of paper.

  2. Work with a classmate to practice administering the Mini-Cog to each other and scoring it accordingly.

  3. If you get stuck or are not sure how to score an item, return to the “Mini-Cog Versions” drop-down menu and select “Administering the Mini-Cog” and/or “Scoring the Mini-Cog.”

  4. You may have questions after working through this exercise, perhaps related to test logistics or next steps. If that is the case, consider returning to the “Mini-Cog Versions” drop-down menu and visiting the “FAQs” page.

This activity is intended to increase your familiarity with a brief, freely available dementia screening tool that is often used in clinical settings and as part of the Medicare Annual Wellness Visit. The Mini-Cog can be administered by any health professional or trained lay health worker.

INTRODUCTION

“I now begin the journey that will lead me into the sunset of my life.” Ronald Reagan

Dementia is an umbrella term used to define the ...

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