Materials for Alzheimer's Disease

• 1) activities in daily living (ADL)
• 2) behavior and personality
• 3) cognition 

• 1) early onset
• 2) normal onset 

• 1) age
• 2) head injury
• 3) depression
• 4) hypertension
• 5) coronary heart disease
• 6) homocysteine
• 7) obesity
• 8) diabetes

• 1) acetylcholine
• 2) glutamate

• 1) histopathological evidence
• 2) course and examination characteristic of AD

• 1) defecits in > 2 areas of cognition
• 2) onset 40-90
• 3) other causes excluded

• 1) deficit in only 1 area of cognition
• 2) atypical course
• 3) other dementia causes present

• 1) sudden onset
• 2) focal signs
• 3) seizures or gait distrubance early in course

• 1) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
• 2) The agency for Healthcare Research and Quality (AHRQ) guidelines
• 3) The American Academy of Neurology Guidelines
• 4) The National Institute of Neurological Communicative Disorders and Stroke (NINCDS)
• 5) The Alzheimer's Disease and Related Disorders Associated (ADRDA) Criteria 

• 1) Folstein MMSE
•   a. 30 point scale = higher scores means better mental functioning
• 2) Alzheimer Disease Assessment Scale - Cognitive (ADAS - cog)
•   a. 70 point scale = lower scores means better mental functioning
• 3) St Louis University Mental Status Examination (SLUMS)
•   a. 30 point scale = higher score means better mental functioning
• 4) Mini-Cog Assessment 
•   a. clock-drawing test and 3 item recall test

• 1) Alzheimer Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL)
•   a.  54 point scale
•   b.  the higher the better
• 2) Functional Assessment Staging (FAST)
•   a. 1-7 scale
•   b. 1 = normal
•   c. 7 = requires care
• 3) Various scales to measure IADLs

• 1) recent memory loss affecting job
• 2) difficulty performing familiar tasks
• 3) problems with language
• 4) disorientation to time or place
• 5) poor or decreased judgement
• 6) problems with abstract thinking
• 7) misplacing things
• 8) changes in mood or behavior
• 9) changes in personality
• 10) loss of initiative

An MMSE score of 26-18.  Difficulty remembering recent events, decline in everyday activites. Withdraws from difficult tasks and hobbies. May deny memory problems.

An MMSE score 17-10. Patient requires helps with ADL. Disoriented with time (can't remember date). Can't remember recent memories.  May forget family members names. May become emotional. Agitation, paranoia, and delusion may be apparent.

An MMSE score of 9-0. Patient loses ability to speak, walk, and eat. May be incontinent.

• 1) Donepezil (Aricept)
• 2) Galantamine (Razadyne)
• 3) Rivastigmine (Exelon) 

• 1) Donepezil (Aricept)
• 2) Galantamine (Razadyne)
• 3) Rivastigmine (Exelon)
• 4) Memantine (Namenda) 

• 1) Donepezil (Aricept)
• 2) Memantine (Namenda)

5 mg tab q.p.m.

10 mg tab q.p.m.

• 4 mg tab BID cf or
• 4 mg oral solution BID  cf or 
• 8 mg cap QD cf (ER)

• 12 mg tab BID cf or
• 12 mg oral solution BID cf or
• 24 mg cap QD cf (ER)

• 1.5 mg cap BID cf or
• 1.5 mg oral solution BID cf or
• 4.6 mg patch QD cf

• 6 mg cap BID cf or
• 6 mg oral solution BID cf or
• 9.5 mg patch QD cf 

• 5 mg tab QD or
• 5 mg oral solution QD

• 10 mg tab BID or
• 10 mg oral solution BID

• 1) N/V/D
• 2) muscle cramps
• 3) urinary incontinence
• 4) syncope
• 5) bradycardia
• 6) fatigue

• 1) CYP3A4 and 2D6 
• 2) anticholinergic medications

• 1) glutamate
• 2) serotonin

• 1) N/V/D
• 2) muscle cramps
• 3) urinary incontinence
• 4) syncope
• 5) bradycardia
• 6) fatigue

CYP3A4 and 2D6

• 1) N/V
• 2) anorexia
• 3) muscle cramps
• 4) bradycardia
• 5) syncope
• 6) fatigue
• 7) urinary incontinence 

• 1) HA
• 2) dizziness
• 3) sedation
• 4) agitation
• 5) constipation
• 6) hypetension
• 7) coughing
• 8) confusion 

• 1) Neuropsychiatric Inventory (NPI)
•   a. 144-point scale
•   b. higher score = severe behavioral problems
• 2) Behavioral Pathology in Alzheimer's Disease
•   a. 75 point scale
•   b. higher score = more behavioral problems
• 3) Cohen-Mansfield Agitation Inventory 
•   a. 203 point scale
•   b. higher score = more behavioral problems 

• 1) cholinesterase inhibitors
• 2) atipical antipsychotics
• 3) valproic acid/carbamezapine
• 4) antidepressants
• 5) memantine

• 1) risperidone (RisperDAL)
• 2) olanzapine (ZyPREXA)

0.25 mg/day

2 mg/day

It is titrated up in increment of 0.25-0.5 mg/day until 1 mg/day is reached.

5-10 mg/day

• 1) somnolence
• 2) EPS
• 3) abnormal gait
• 4) worsening cognition
• 5) cerebrovascular events
• 6) increased risk of death
• 7) hypotension

• 1) citalopram (CeleXA)
• 2) sertraline (Zoloft)

• 1) carbamazepine (Carbatrol, Epitol, Equetro, TEGretol)
• 2) valproic acid (Depacon, Depakene, Stavzor)

• 1) zolpidem (Ambien)
• 2) buspirone (Bustab, Buspirex, BuSpar)