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Alzheimer s Disease: Diagnosis and Treatment

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Alzheimer s Disease: Diagnosis and Treatment

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    1. Alzheimer’s Disease: Diagnosis and Treatment Mukaila Raji MD; MSc, Assistant Professor & Director, Memory Loss Clinics Division of Geriatric Medicine, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas 77555-0460

    2. Dementia Acquired syndrome of decline in memory and at least one other cognitive function (e.g.apraxia, aphasia, agnosia) sufficient to affect daily life in an alert person. Small et al. JAMA 1997;278:1363-1371

    4. Prevalence of Alzheimer’s

    5. AD is the third most costly disease after cardiovascular disorders and cancers.

    6. Pathology of Alzheimer’s disease Severe loss of cholinergic neurons in the basal forebrain Reduced level of acetylcholine at hippocampus and other cortical areas for memory and learning. Formation of amyloid plaques, neuritic tangles and brain atrophy.

    7. Causes of primary dementing illnesses: Alzheimer’s disease: 70% of all dementia Vascular dementia, Lewy Body dementia Frontotemporal dementia Pick’s disease

    8. Risk and Protective Factors for Alzheimer’s Disease   Aging, History of head injury with loss of consciousness Family history of AD or and Down’s syndrome, Apolipoprotein E4 genotype Mutations on presenilin1 & 2 genes (rare) Possible Protective factors: higher education, prior use of non-steroidal anti-inflammatory drugs

    9. RATIONALE FOR EARLY DIAGNOSIS OF AD:   1)Addressing safety issues to minimize hazards from driving, cooking, and over-medications.   2)Reduction of caregivers’ stress via early education about the disease, community services and how to handle the patient needs.   3)Specific treatments that are available work best when started in the early part of the illness.

    10. CLINICAL FEATURES: Amnesia- forgetfulness Aphasia- language difficulty Agnosia- naming and recognition problems Apraxia- difficulty with doing tasks such as dressing, bathing etc Disorientation- getting lost

    11. Clinical features cont’d Personality changes- apathy, irritability Psychiatric symptoms of psychosis, depression, aggression and anxiety Executive dysfunction- impulse dyscontrol, poor planning and judgment

    12. Observations by health staff may point to early AD   Decline in hygiene, grooming and other self-care activities Recurrent pattern of missed appointments Poor recall of important health events such as hip replacement Patient refers most questions to family members

    13. Observations by health staff Cont’d Getting angry when asked questions about memory Poor nutritional status and weight loss Recent diagnosis of major depression, psychosis or delirium Use of Gingko Biloba and other “memory enhancers” Poor adherence to needed therapy

    14. Diagnostic Workup For Dementia   History from both the patient and a reliable informer   Comprehensive physical examination including brief mental status and neurologic evaluation. MMSE is recommended for quantifying cognitive function. Clock drawing Task can also be done especially for quick screening.   Laboratory evaluations include CBC, chemistries, RPR, Liver Function Tests, TSH, Vitamin B12 and RBC folate levels. Imaging studies such as CT scan and MRI are optional depending on clinical findings.

    15. Causes and Aggravators of Apparent Dementia   D-Drugs E-Emotional illness including depression M-Metabolic/endocrine disorders E-Eyes/ear/environment T-Tumors/trauma I-Infection A-Alcoholism/anemia/atherosclerosis

    16. Treatment of Alzheimer’s disease Early Cholinesterase Inhibitors Therapy May Slow Decline in Cognition, Function and Behavior.

    19. Conclusion: a) Alzheimer’s Disease, the most common cause of dementia in the elderly, is essentially a clinical diagnosis of inclusion.  b) All older patients, particularly those with a decline in activities of daily living, behavior and cognition, should be screened for possible dementia. The caregiver is crucial to diagnosis and effective management.  c) Early therapeutic interventions with cholinesterase inhibitors, appropriate use of psychotropic medications and targeted screened for Alzheimer’s disease, by using MMSE or/and Clock Drawing Task.  

    20. Conclusion cont’d: d) Early diagnosis of AD is crucial for optimal symptomatic therapy of both AD and other comorbidities, for caregiver burden reduction, advance planning and reduction of hazardous events.   e) Behavioral modifications, in a setting of multidisciplinary team of social workers, nurses, clinicians, pharmacists, rehabilitation staff, dietitians and psychiatrists provide the greatest benefit to patients and their families.

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