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UPDATE SUMMARY

Update Summary

June 24, 2023

The following sections and tables were updated:

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer Handbook, please go to Chapter 53, Alzheimer Disease.

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 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.

  • 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 ...

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