6.5 - Psychotropic Drugs in Treating Dementia (Alzheimer's Specific)

What is dementia?

Extensive destruction of neuronal activity in the brain due to neuronal plaque formation

What are the goals of drug therapy in dementia?

• Improve cognition, memory, and intellectual function

• Improve or modify behavior

What is currently available to improve cognitive function?

Cholinergic stimulant drugs to increase ACh activity either directly or indirectly

Why are cholinergic drugs thought to improve cognitive function?

• ACh necessary for various structures in brain and body

• Neuronal changes lead to decreased acetylcholine formation

What are indirect cholinergic stimulants effects in dementia?

• Drugs inhibit enzyme that breaks down ACh

  • Cholinesterase enzyme

• Causes ACh activity and effects to be prolonged

What are current cholinergic stimulants?

• Donepezil

• Galantamine

• Rivastigimine

• Tacrine

When are cholinergic stimulants to be used?

• Improve cognition and behavioral functions

  • Made especially for alzheimer’s/dementia diseases

  • Help patients retain more cognitive/intellectual function in early AD

What happens if cholinergic drugs stop having an effect?

• Effectiveness is often lost when neurons have been degenerated beyond a certain point

• Drugs prolong the effects of ACh after it has been released

• If neurons are degenerated and do not produce ACh drug will cease to function properly

What is the memantine (namenda) drug?

• Newer option for AD treatment

• Blocks NMDA-glutamate receptors in brain such as glutamate

  • Glutamate is an excitatory amino acid important in memory and learning

  • NMDA-glutamate thought to be over stimulated causing AD

  • Glutamate activity is disrupted in AD, drug therapy normalizes its influence

What is the common drug combining for AD?

• Donepezil + memantine = Zamzaric

• Combination of 2 drugs in one pill

What is the purpose of each drug combined for AD?

• Memantine slows the progression of AD

• Donezepil prolongs the effects of ACh

  • Cholinergic stimulant

What are benefits of drug combining for AD?

• Increased adherence

  • Less pills, less dosing schedules, easier to remember

What is the newest anti-AD drugs?

• Aduhelm (Aducanumab)

• Accelerated approval by FDA in June 2021

• Decreases the ability for antibodies to bind to amyloid beta protein fragments and decreases their ability to accumulate plaques in brain

• Monthly IV injection

What is the biggest controversy of the aduhelm (aducanumab) anti-AD drug?

• Cost: approx. $56,000/year

• No conclusive evidence of its effectiveness

What are drugs used to improve and modify behavior?

• Anti-depressants

• Anti-anxiety agents

• Ant-psychotics

What is symptom-specific medication?

Prescribing drugs that treat the more prevalent and specific symptoms experienced

Why did the government implement regulations on the use of anti-psychotics?

• Due to inappropriate and overuse of drug in controlling agitated patients rather than treating their true symptoms

  • Drug used as a chemical restraint

What is an example of a non-pharmacological interventions that can help improve behavior?

• Put things in their environment that they identify with

  • Increases familiarity and comfort for patients in spaces they are unfamiliar with

  • Increases reassurance in patient