dr. adeniyi mofoluwake and stacy kramerwp.cune.org/...and-kramer-mph-543-alzheimers-ppt.pdf ·...
TRANSCRIPT
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Dr. Adeniyi Mofoluwake
and
Stacy Kramer
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Definition of Alzheimer’s Disease
Alzheimer's disease is a neurological disorder in which insidious onset of the death of brain cells causes memory loss and cognitive decline.
It is a neurodegenerative type of dementia.
Alzheimer’s disease is the most type of dementia.
It is responsible for 60% to 80% of dementias.
It causes problems with memory, thinking and behavior.
It develops insidiously, worsens overtime and becomes severe enough tointerfere with one’s daily activities.
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Risk factors of Alzheimer’s disease
Preventable Risk Factors
Factors that increase blood vessel
risk
Low educational and occupational
attainment
Previous head injury and the severity
of the head injury
Repeated mild traumatic brain injury
Sleep disorders like sleep apnea
Estrogen replacement therapy
Social and cognitive engagement
Mental and social inactivity
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Unavoidable Risk Factors
Increasing age
Inheriting a “risk” gene or a “deterministic” gene
The -e4 copy of the Apolipoprotein APOE gene is a
“risk” gene that increases likelihood of Alzheimer’s.
The amyloidprecurson protein (APP), presenilin-1
(PS-1), and presenilin-2 (PS-2)genes are
“deterministic” genes found to cause an inherited
form of Alzheimer’s.
Being female
Family history
\alzheimers\supplementary-the-role-of-genetics-in-alzheimers.html
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Stages of Alzheimer’s diseaseThere are three clinical stages of Alzheimer’s disease.
Preclinical stage
This is an asymptomatic stage but there are significant
changes in the brain, cerebrospinal fluid and or blood.
Mild cognitive impairment
At this stage friends and family might notice significant
changes in the ability to think but these individuals
living with Alzheimer’s disease still go about their day
to day activities normally.
Dementia
Individuals experience memory, thinking and behavioral
symptoms that inhibit their functioning at this stage.
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Image courtesy of G.J. Huba (2013).
Stages of Alzheimer’s Mind Map
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Manifestations of the Stages of Alzheimer’s DiseaseEarly stages of Alzheimer’s disease
Mild memory loss – friends, family or coworkers may begin to notice
Noticeable problems coming up with the right word or name
Trouble remembering names when introduced to new people
Having greater difficulty performing tasks in social or work settings.
Forgetting material that one has just read
Losing or misplacing a valuable object
Increasing trouble with planning or organizing
Essentially, having a decreased ability to take in and retain new information
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Manifestations of the Stages of Alzheimer’s Disease
Mild-Moderately Severe Stages of Alzheimer’s Disease
Impaired ability to perform challenging mental arithmetic (i.e. counting
backward from 100 by 7s)
Difficulty performing tasks, such as planning dinner for guests, paying
bills or managing finances
Forgetfulness about one's own personal history
Becoming moody or withdrawn,
Be unable to recall their own address, telephone number, high school, etc.
Become confused about where they are or what day it is
Less challenging arithmetic becomes hard (i.e. count back from 20 by 2s)
Need help choosing proper clothing for the season or the occasion
Still remember significant details about themselves and their family
Still require no assistance with eating or using the toilet
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Late stages of Alzheimer’s disease
Disorientation
Mood and behavioral changes
Difficulty with speaking, swallowing and walking
Worsening behavioral changes, memory loss, confusion about events,
times, and locations
Unfounded suspicions about family, friends and professional
caregivers
Loss of the ability to converse and respond to the environment
Dependence on others for basic activities of life like bathing, dressing,
eating and using the bathroom.
Inability to communicate and recognize loved ones
Manifestations of the Stages of Alzheimer’s Disease
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Alzheimer’s DiseaseAlzheimer’s progresses in stages and at varying rates for
every individual.
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Costs of Alzheimer's Disease
Direct
• Health care
• Insurance
• Long term care facility
Indirect
• Home health aide
• Familial support
• Family caregiver
• Stress of caregiver
• Increased health costs of care giver
Alzheimer’s
Costs
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Issues experienced by families
and caregivers include:
•Denial
•Anger / Frustration
•Guilt
•Loss and Grief
•Letting Go
•Financial Stress
•Role Reversals
•Social Isolation
Indirect Costs of Alzheimer's Disease
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Overall Financial and Healthcare Impact
• The main component of the dementia costs is
for institutional and home-based long-term
care rather than medical services.
• The cost of nursing home care, and formal
and informal home care comprise 75% to
84%of dementia costs.
•People with Alzheimer’s disease and related
dementias have three times as many hospital
stays as do others.
Direct Costs of Alzheimer's Disease
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What is it?
• Possible drug treatment for Alzheimer’s
• Cholinesterase inhibitors (ChEIs) slow the
activity of cholinesterase (an enzyme that
decreases the amount of acetylcholine),
making more acetylcholine available for
communication between cells.
Cholinesterase Inhibitor
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Why are they important?
• Because a cholinesterase inhibitor slows the
activity of cholinesterase, more acetylcholine is
available.
•When more acetylcholine is available:
• apathy and anxiety can be alleviated
•alertness, motivation, and memory
can be improved
Cholinesterase Inhibitor
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The Use of Cholinesterase Inhibitors to
Treat Alzheimer’s Disease
• Cholinesterase inhibitors are NOT a cure for
Alzheimer’s. They do:
•help the damaged regions of the brain function
better, which in turn slows down the emergence of
symptoms and improves your loved one’s quality
of life.
• slow the activity of cholinesterase, making more
acetylcholine available for communication
between cells.
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Benefits of the Three Drug Treatment Options
Donepezil(Aricept)
Improves mental function
Improves cognitive benefits to a
level that exceeds the minimum
clinically important difference and
significant functional benefits over
the course of 12 months
Approved to treat all stages of
Alzheimer's disease
Elimination is through the liver
Option #1:
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Benefits of the Three Drug Treatment Options
Rivastigmine(Exelon)
Approved to treat mild to moderate
Alzheimer’s disease
Improves cognition, activities of daily
living, and global function.
Has relatively low protein-binding
characteristics hence, it has a minimal
potential to significantly interact with
other drugs.
Option #2:
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Benefits of the Three Drug Treatment Options
Galantamine (Razadyne)
Approved to treat mild to moderate
Alzheimer’s disease
Improves cognition, activities of daily
living, and global function.
Inhibits AChE
Modulates nicotinic receptors
Elimination pathway is through the
kidney and liver
Option #3:
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Potential Side Effects of the Three
Cholinesterase Inhibitors:
Nausea, vomiting,
diarrhea;
Loss of appetite;
Muscle cramps;
Fatigue
Insomnia black, bloody,
or tarry stools;
• Black, bloody, or tarrystools
• Coughing up blood orvomit that looks like blood
or coffee grounds
•Difficultly urinating• Seizures• Impaired thinking andreactions
Donepezil (Aricept)
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Potential Side Effects of the Three
Cholinesterase Inhibitors:
Nausea, vomiting, loss of
appetite,
Joint pain
Dizziness, drowsiness,
tremors
Bradycardia, arrhythmias,
fainting
Increased sweating
Sleep problems
Cough, runny nose,
headache
Black, bloody, or tarry
stools
Severe abdominal pains
Seizures
Pain with urinating
Allergic reactions ( rash,
itching, swelling of the
face/tongue/throat)
Severe dizziness
Confusion, agitation, fear
Rivastigmine(Exelon)
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Potential Side Effects of the Three
Cholinesterase Inhibitors:
Feeling tired, dizzy, or
light-headed;
Nausea, vomiting, gas,
loss of appetite;
Weight loss
Headache
Chest pain, slow heart rate
Black, bloody, or tarry stools;
Coughing up blood or vomit
that looks like coffee grounds;
Weakness, confusion,
decreased sweating, extreme
thirst, hot dry skin
Urinating less than usual or
not at all
Galantamine (Razadyne)
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Is One Cholinesterase Inhibitor Better? All cholinesterase inhibitors appear to work equally well.
Aricept has been on the market longer and therefore
seems to be prescribed more often.
Potential long-term side effects are
different
If one doesn’t work, try a different
one
There is experimental evidence that switching can often
help, by providing superior efficacy, reducing side effects,
or both (Alzheimer’s Compendium, 2014).
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Rationale for Funding Decision
Alzheimer’s disease is the 6th leading cause of death in the US and the 5th leading cause of death in persons aged65 and up.
As the United States’ population ages, the incidence of Alzheimer’s disease will increase
There is a significant increase in deaths from Alzheimer’s disease expected as US age increases.
• Over the next fiveyears, 5% to 15% of
deaths in older people
will be attributed to
Alzheimer’s
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Rationale for Funding Decision
• These cholinesterase inhibitors are currently
one of few known ways to simply help the
damaged brain function better than it would
without them.
• While the length of time they are effective is
not specifically known, they have been
proven to improve function in many people
suffering from Alzheimer’s.
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While there is still much to be learned about Alzheimer’s
such as:
the exact changes (and their order) that trigger the
development
symptoms, causes, risk factors, and treatment
better understanding of how social and cognitive
engagement may affect biological processes to reduce
the risk of this disease.
We know the public health impact of Alzheimer’s is
significant and the paradigm shift to health promotion calls
for further researchin order toprevent Alzheimer’s disease
Rationale for Funding Decision
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ReferencesAlzheimer’s Association, (2013). Alzheimer’s disease facts and figures.
RetrievedFebruary 7, 2014, from http://www.alz.org/downloads/facts_figures_2013.pdf
Alzheimer’s Association, (2014). What is Alzheimer’s? Retrieved fromhttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asp#research
Alzheimer’s Association. (2014). The search for Alzheimer’s causes and risk
factors. Retrieved from http://www.alz.org/research/science/alzheimers_disease_causes.asp
Alzheimer’s Compendium. (2014). Alzheimer’s drugs: Fact and Opinion.
Retrieved from http://www.alzcompend.info/?p=244
Alzheimer’s Society (2014). Leading the fight against dementia. Retrieved
from http://www.alzheimers.org.uk/404.php
Healthcare Professionals Network. (2012). Cognitive benefits with continued donepezil in Alzheimer’s. Retrieved from
http://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimers
Huba, G.J. (2013). #Dementia and “Typical” #Aging: Examples of (Better???)
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ReferencesMayo Clinic. (2011). Diseases and conditions: Alzheimer's still has no
cure, but twodifferent types of drugs can help manage symptoms of the disease. Retrieved fromhttp://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103
Medical News Today, (2013). What is Alzheimer's disease? Causes, symptoms andtreatment. Retrieved from http://www.medicalnewstoday.com/articles/159442.php
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Wilkinson, D.G., Francis, P.T., Schwam, E., and Payne-Parrish, J. (2004). Cholinesterase inhibitors used in the treatment of Alzheimer's disease: the relationship between pharmacological effects and clinical efficacy. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15132713
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