ALZHEIMERS DISEASE

CPHARM 2

Alzheimer’s Disease

Neurodegenerative Disease that is exemplified by memory or cognitive loss

Mild cognitive impairment (MCI)

often proceeds with dementia, but not in all cases progress to dementia.

Gene susceptibility

genes have a role in the etiopathogenesis of AD

Apolipoprotein E (ApoE).

The late onset of AD is link to

Apolipoprotein E (ApoE).

It has a problem that when interacted with the environment it can actually trigger AD

aberrations in chromosomes that until now in unknown

AD is dominantly secondary to

• Age

• In CT or MRI, if there is a brain shrinkage of atrophy or decrease brain reserve capacity and injury it can be a sign of AD

• Down syndrome

• Depression

• MCI, Mild cognitive impairment (MCI)

• Lipid factors that would produce abnormalities on the lipid inside the body, especially to those with amino acid, elevated homocysteine

• Metabolic syndrome (diabetes)

• Stroke

Risk factors:

it is apparent that there is a signature lesion of the brain that is almost present which are amyloid plaques and intracellular neurofibrillary tangles (NFTs) in the temporal load (responsible for memory)

After the diagnosis of AD and the brain is opened

amyloid plaques and intracellular neurofibrillary tangles (NFTs)

Where does the signature lesion exists

Brain atrophy

apparent during CT scan or MRI

• Accumulation of amyloid protein (Beta-amyloid protein)

• The hyperphosphorylation of the TAU proteins that leads to neurofibrillary tangles

• Depletion of the brain derived from neurotrophic factors and depletion of Neurotransmitter brain-derived

• It can be secondary to mitochondrial dysfunction and oxidative stress.

• Loss of Cholinergic activity

Mechanism of appearance of NFT and amyloid

In some instances, there is a memory loss or being forgetful.

Affects judgement of a patient

Affects certain orientation of a patient

Early possibility of AD

Behaviors that are rarely seen

Unable to take care of themselves

Late Stages of AD

Mild

Moderate

Severe – unable to function well.

Stage of AD

Mini-Mental State/Status Examination - Scoring system

(MMSE)

Asymptomatically during the pre-clinical phase

AD is a difficult disease to diagnose since it starts as

clinically (kung ano yung ginagawa ng patients). This includes the history and physical exam of the patient which can exclude the possibility of AD.

AD is diagnosed

“waste basket disease” or exclusion diagnosis. Pag wala nang maidiagnose at ganun ang symptoms is possible AD.

AD is considered as

DNA/Genetic study

can be useful by examining the chromosomes that yield the production of ApoE and the formation of amyloid plaque can help diagnose AD

Substance abuse
Patient does not have any head trauma or injury

Patient’s medication history

People can get into delirium with drugs

mimicry of AD

• NSAIDS

• H2 receptor blockers

• Antihypertensives

• Antiarrhythmic drugs (amiodarone)

• Steroids

• Corticosteroids

People can get into delirium with drugs

Maintain cognitive functioning

Treat the possibility of behavioral problems that would arise from AD

Goal of Treatment

1. Try to look for reasons for the forgetfulness of the patient (maybe the lack of Vitamin B12 or give food that can strengthen the function of the brain).

2. Adapt a system in the house that would allow the patient to stimulate the function of their brain and do more cognitive functioning.

3. Sleep disturbances/Incontinence should be corrected by educating the patients.

4. Try to find triggers of certain illnesses that would probably a sign that the patient has AD.

NON-Pharmacologic Treatment

ANTI-AMYLOID MONOCLONAL ANTIBODY

CHOLINESTERASE INHIBITORS

CHOLINESTERASE INHIBITORS

Pharmacologic (Not guaranteed)

ANTI-AMYLOID MONOCLONAL ANTIBODY

Promising but still underworks. There is a slow decline in the progression of AD

ANTI-AMYLOID MONOCLONAL ANTIBODY

Destroy or Prevent the formation of the amyloid plaques

Aducanumab

Lecanemab

Donanemab

Gantenerumab

ANTI-AMYLOID MONOCLONAL ANTIBODY

CHOLINESTERASE INHIBITORS

For mild to moderate AD

Donepezil

Rivastigmine

Galantamine

CHOLINESTERASE INHIBITORS

Memantine

ANTIGLUTAMATERGIC THERAPY / RECEPTOR AGONIST

Memantine

is the only NMDA receptor antagonist available for AD

Estrogen

Given to menopausal women

NSAIDs

Corticosteroid

Statins.

Nutrition Supplement: Ginko Biloba, Vitamin E, Omega-3-Fatty Acids

Other Drugs for AD

1. Adherence

2. Overdosing

If a patient starts to have psychiatric problems. Antipsychotics can be given but be cautious

Give antidepressants

If a patient is depressed

Treat appropriately either antipsychotics drug, SSRIs may be used

A patient who has progressive psychological symptoms, secondary to Dementia: