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  • Image not available. Alzheimer's disease (AD) is the most common form of dementing illness, and the prevalence of AD increases with each decade of life.
  • Image not available. The etiology of AD is unknown, and current pharmacotherapy neither cures nor arrests the pathophysiology.
  • Image not available.Neuritic plaques and neurofibrillary tangles are the pathologic hallmarks of AD; however, the definitive cause of this disease is yet to be determined.
  • Image not available. AD affects multiple areas of cognition and is characterized by a gradual onset with a slow, progressive decline.
  • Image not available. A 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.
  • Image not available. Pharmacotherapy for AD focuses on impacting three domains: cognition, behavioral and psychiatric symptoms, and functional ability.
  • Image not available. Nondrug therapy and social support for the patient and family are the primary treatment interventions for AD.
  • Image not available. Cholinesterase 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.
  • Image not available. Appropriate management of vascular disease risk factors may reduce the risk for developing AD and may prevent the worsening of dementia in patients with AD.
  • Image not available. A thorough behavioral assessment and plan with careful examination of environmental factors should be conducted before initiating drug therapy for behavioral symptoms.
  • Image not available. Pharmacotherapy may reduce the total cost of treating AD by delaying cognitive decline and time to nursing home placement.

Upon completion of the chapter, the reader will be able to:

  • 1. List the most common types of dementia in late life.
  • 2. Distinguish between early-onset and late-onset Alzheimer’s disease (AD).
  • 3. Discuss genetic and environmental causes that can play a role in the etiology of AD.
  • 4. Identify the hallmark pathophysiologic lesions in AD.
  • 5. Identify the neurotransmitter systems affected by AD.
  • 6. Discuss the importance of brain vascular health in AD.
  • 7. Describe the signs and symptoms of various stages of AD.
  • 8. Discuss the diagnostic criteria for AD.
  • 9. Explain the primary treatment goals of both pharmacologic and nonpharmacologic therapies for AD.
  • 10. Describe the general approach to developing nonpharmacologic strategies for managing behavioral symptoms in patients with AD.
  • 11. Discuss the mechanism of action, dosing, administration, and side-effect profiles of the available cholinesterase inhibitors.
  • 12. Discuss the mechanism of action, dosing, administration, and side-effect profile of memantine.
  • 13. Discuss the advantages and disadvantages of estrogen, antiinflammatory agents, lipid-lowering agents, and dietary supplements (vitamin E, Ginkgo biloba, huperzine A, omega-3 fatty acid, and medical foods) as treatments for patients with AD.
  • 14. Develop a treatment and monitoring plan for cognitive symptoms in a patient newly diagnosed with mild AD.
  • 15. List available treatment options and recommended dosages for behavioral symptoms of AD.
  • 16. Explain the risks associated with antipsychotic use in patients with AD.
  • 17. Evaluate the economic impact of AD.

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