psych/neuro AD and PD

what are example of subjective info in AD pts

(1) decline in cognition (memory)

(2) info from caretaker

what are examples of objective info in AD pts

mental status tests are ABNORMAL

what are the main mental status tests?

(1) MMSE (mini-mental status exam)

(2) MoCA (montreal cognitive assessment)

what specific objective tests are done in AD pts

CSF (brain fluid) amyloid

MRI to show atrophy in temporal lobe

amyloid PET scan

what tests can be used to show disease severity/progression in AD

MMSE and MoCA

what level of cognitive impairment do the score ranges represent in the MMSE?

⚫️ 24-30 = No cognitive impairment

⚫️ 17-23 = Mild

⚫️ 10-16 = Moderate

⚫️ < 10 = Severe

what level of cognitive impairment do the score ranges represent in the MoCA?

⚫️ 26-30 = No cognitive impairment

⚫️ 18-25 = Mild

⚫️ 10-17 = Moderate

⚫️ < 10 = Severe

what are the 2 main mABs

lecanemab and donanemab

what is the MOA of mABs

monoclonal antibody directed against B-amyloid

what is the indication for mABs

(1) mild cognitive impairment

(2) mild dementia stage of AD

how are mABs administered

IV infusion

how often is lecanemab infused

q 2 weeks

how often is donanemab infused

q 4 weeks

what is the boxed warning for mABs

ARIA (amyloid-related imaging abnormalities):

(1) ARIA-E = brain swelling

(2) ARIA-H = brain microhemorrhages

what increases the risk of ARIA

positive for APOE4 genotype

which mAB has a lower risk for ARIA

lecanemab

how do you monitor for ARIA

frequent MRIs (q6months-1yr)

what are the other issues of mABs

(1) infusion reaction

(2) efficacy is modest

(3) super expensive

what is the main AChE-I

donepezil (Aricept)

what is the typical dose for donepezil

10mg

what is the route of donepezil

(1) PO

(2) ODT

(3) patch

what are the adverse effects of AChE-I

(1) GI

(2) bradycardia

(3) hypotension ==> orthostasis

t/f a consultation point for AChE-I is give on empty stomach

false; give with food

what are the AChE-I DDI

AChE-I increase ACh and anticholinergics block

is AChE-I and anticholinergics a toxic combo

no, they just counteract each other

what are the common OTC anticholinergics

(1) diphenydramine (Benadryl)

(2) Nyquil PM,

(3) Tylenol PM

who should avoid anticholinergics

pts with dementia because they already have memory problems

give an example of NMDA-R antagonist

memantine (Namenda)

what is the indication for NMDA-R antagonist

moderate to severe AD

what is NMDA-R antagonist used with

can be used alone or with an existing AChE-I

what is the MOA of NMDA-R antagonist

blocks NMDA-R responsible for excitotoxicity

memantine comes in a combo pill with _____

donepezil

how do you monitor efficacy in AD pts

MMSE or MoCA

which side effects should be monitored with AD therapies

(1) GI upset

(2) heart rate

(3) BP

are antidepresseants effective in AD

no

what psych meds are used in AD

atypical antipsychotics

what is the FDA warning for antipsychotics in AD pts

may increase mortality

why might antipsychotics still be used in AD patients

benefits outweigh the risk

what is delirium

state of acute cognitive impairment

what are the pharmacologic interventions for delirium

low-dose antipsychotics (haloperidol PRN, atypical antipsychotics)

what drugs do you want to avoid in delirium pts

benzodiazepines (may worsen delirium)

what is another type of dementia

vascular dementia

how are vascular dementia caused

ischemic strokes in brain areas involved in cognition

what are the risk factors for vascular dementia

(1) high BP

(2) diabetes

(3) high cholesterol