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Update Summary
June 24, 2023
The following sections and tables were updated:
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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the Chapter in the Schwinghammer Handbook, please go to Chapter 53, Alzheimer Disease.
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KEY CONCEPTS
Alzheimer disease (AD) is the most common cause of dementia, the prevalence of which increases with each decade of life.
The etiology of AD is unknown, and current pharmacotherapy neither cures nor arrests its pathophysiology.
Amyloid plaques and neurofibrillary tangles (NFTs) are the pathologic hallmarks of AD; however, the definitive cause of this disease is yet to be determined.
AD affects multiple areas of cognition and is characterized by a gradual onset with a slow, progressive decline.
A 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.
Pharmacotherapy for AD focuses on impacting three domains: (1) cognition, (2) neuropsychiatric symptoms, and (3) functional ability.
Nonmedication therapy and social support for the patient and family are the primary treatment interventions for AD.
Cholinesterase inhibitors and memantine are used to treat cognitive symptoms of AD, whereas immunotherapies may have the potential to be disease-modifying.
Aducanumab and lecanemab, amyloid beta-directed antibodies, were Food and Drug Administration (FDA) approved recently for AD via accelerated approval. Two other agents have been designated breakthrough therapy and are continuing to be evaluated.
Appropriate management of vascular disease risk factors may reduce the risk for developing AD and may prevent the worsening of dementia in people with AD.
A 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.
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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:
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.
Work with a classmate to practice administering the Mini-Cog to each other and scoring it accordingly.
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.”
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 ...