Term
| What are the primary ddx's for alz dz? |
|
Definition
pseudodementia of depression
stroke
Parkinson's dz
Alcoholism and acute thiamine deficiency
drug induced delirium |
|
|
Term
| What are ways to reduce alz dz risk? |
|
Definition
keep mind active
keep a sense of purpose
low fat diet w/ increased fish consumption
statin drugs
estrogen replacement therapy? TBD.
Anti-oxidants (Vit E)
exercise
manage HTN, DM, hyperlipidemia |
|
|
Term
| What is the main tx class for alz dz? |
|
Definition
| cholinesterase inhibition |
|
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Term
| What are the primary cholinesterase inhibition drugs for alz. Dz? |
|
Definition
Donepezil
Galantamine
Rivastigmine |
|
|
Term
| What are the dosage schedules for cholinesterase inhibition alz dz drugs? |
|
Definition
Donepezil - qhs
Galantamine - q.d. dosage (morning)
Rivastigmine - b.i.d. or by skin patch |
|
|
Term
| What are the current non cholinesterase inhibition alz drugs? |
|
Definition
memantine - b.i.d. for moderate or severe AD, provides neuroprotection
Selegiline - q.d.; inhibits MAO-B, an enzyme that breaks down dopamine |
|
|
Term
| What drug tandem is used to treat AD? |
|
Definition
| donepezil and memantine together have slowed progression of AD |
|
|
Term
| Why is proper eyewear Rx important for AD? |
|
Definition
| Sharp visual acuity increases mental stimulation (slows progression) and mobility; decreases disorientation |
|
|
Term
| What % of AD pt's has improper eyewear usage? |
|
Definition
|
|
Term
| What are potential future tx's of AD? |
|
Definition
alpha-secretase activation
beta-secretase enzyme inhibition
gamma-secretase modulation
monoclonal Ab --> beta amyloid IV gamma globulin (IgG Ab) |
|
|
Term
|
Definition
| alpha-secretase activating enzyme |
|
|
Term
|
Definition
| beta-secretase inhibition enzyme |
|
|
Term
| What is tarenflurbil and tamiprostate? |
|
Definition
| gamma-secretase modulation drugs, may be future AD tx |
|
|
Term
| What does AD do to the expected remaining life expectancy? |
|
Definition
| remaining life expectancy cut roughly in half |
|
|
Term
| What is the average lifespan from moment of AD dx? |
|
Definition
| 4.2 yrs for men, 5.7 yrs for women; i.e. men die sooner |
|
|
Term
| What are comorbidities that will accelerate AD related death? |
|
Definition
non ambulatory
incontinence
DM
Heart dz
rapid brain function decline |
|
|
Term
|
Definition
it puts the brakes on the extra signals in the brain via glutamate supression, allowing the brain to focus better on pertinent information
Glutamate excess --> excess neural activity/noise --> excitotoxicity/apoptosis |
|
|
Term
| What does MAO-B stand for? |
|
Definition
|
|
Term
| With AD drugs, what are the main biochemical goals? |
|
Definition
Prevent ACH loss
Prevent dopamine loss |
|
|
Term
| What does VVAD stand for? |
|
Definition
| Visual variant Alzheimer dz |
|
|
Term
|
Definition
less common form of alz dz that disrupts higher order visual processing
affects posterior cortical area primarily
insight is less affected |
|
|
Term
| What does neuroimaging of VVAD reveal? |
|
Definition
| occipitoparietal hypometabolism of glucose |
|
|
Term
| What are initial symptoms of VVAD? |
|
Definition
reading and driving difficulties
can see, but can't process what they see (reading problems, etc)
difficulty reading own hand-writing, recognizing faces or objects
depth perception difficulty
However, standard optometric exam appears normal |
|
|
Term
| What is visual object agnosia? |
|
Definition
| can't recognize object by sight, but can by touch or sound |
|
|
Term
|
Definition
| can't recognize faces, but can recognize voices |
|
|
Term
|
Definition
can't generate effective saccades
saccades will take very long, segmented, circuitous routes to the intended target |
|
|
Term
|
Definition
| inability to see more than one object at a time |
|
|
Term
| What is the occurrence of parkinsons dz? |
|
Definition
1% of pt's >50
4th most common neurologic disorder in elderly |
|
|
Term
| What is the primary pathology of Parkinson's dz? |
|
Definition
| dopamine/ACH balance is disturbed |
|
|
Term
| Where are the Parkinson related neurons located? |
|
Definition
|
|
Term
| What can be a non genetic cause of Parkinsons? |
|
Definition
| exposure to pesticides and industrial cleaners |
|
|
Term
| What are early s/sx of parkinsons? |
|
Definition
|
|
Term
| What is the nature of Parkinson related tremors? |
|
Definition
4-7 hz and most conspicuous at rest
rhythmic flexion-extension of fingers, hand or foot (pill-rolling)
initially unilateral |
|
|
Term
|
Definition
| motor slowness seen in Parkinson's |
|
|
Term
| What are the 5 characteristics of parkinson related hypokinesia? |
|
Definition
loss of automatic movements
face is immobile
Most disabling feature of Parkinson's
Voice is hypophonic (weak) and of poor modulation
Handwriting is small and tremulous |
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|
Term
| What is the effectiveness of Acetylcholinesterase Inhibitor drugs for Alz Dz? |
|
Definition
|
|
Term
| What are the SE's of Acetylcholinesterase Inhibitor drugs? |
|
Definition
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