Dr. Adeniyi Mofoluwake

and

Stacy Kramer

Definition of Alzheimer’s Disease

Alzheimer's disease is a neurological disorder in which insidious onset of the death of brain cells causes memory loss and cognitive decline.

It is a neurodegenerative type of dementia.

Alzheimer’s disease is the most type of dementia.

It is responsible for 60% to 80% of dementias.

It causes problems with memory, thinking and behavior.

It develops insidiously, worsens overtime and becomes severe enough tointerfere with one’s daily activities.

Risk factors of Alzheimer’s disease

Preventable Risk Factors

Factors that increase blood vessel

risk

Low educational and occupational

attainment

Previous head injury and the severity

of the head injury

Repeated mild traumatic brain injury

Sleep disorders like sleep apnea

Estrogen replacement therapy

Social and cognitive engagement

Mental and social inactivity

Unavoidable Risk Factors

Increasing age

Inheriting a “risk” gene or a “deterministic” gene

The -e4 copy of the Apolipoprotein APOE gene is a

“risk” gene that increases likelihood of Alzheimer’s.

The amyloidprecurson protein (APP), presenilin-1

(PS-1), and presenilin-2 (PS-2)genes are

“deterministic” genes found to cause an inherited

form of Alzheimer’s.

Being female

Family history

\alzheimers\supplementary-the-role-of-genetics-in-alzheimers.html

Stages of Alzheimer’s diseaseThere are three clinical stages of Alzheimer’s disease.

Preclinical stage

This is an asymptomatic stage but there are significant

changes in the brain, cerebrospinal fluid and or blood.

Mild cognitive impairment

At this stage friends and family might notice significant

changes in the ability to think but these individuals

living with Alzheimer’s disease still go about their day

to day activities normally.

Dementia

Individuals experience memory, thinking and behavioral

symptoms that inhibit their functioning at this stage.

Image courtesy of G.J. Huba (2013).

Stages of Alzheimer’s Mind Map

Manifestations of the Stages of Alzheimer’s DiseaseEarly stages of Alzheimer’s disease

Mild memory loss – friends, family or coworkers may begin to notice

Noticeable problems coming up with the right word or name

Trouble remembering names when introduced to new people

Having greater difficulty performing tasks in social or work settings.

Forgetting material that one has just read

Losing or misplacing a valuable object

Increasing trouble with planning or organizing

Essentially, having a decreased ability to take in and retain new information

Manifestations of the Stages of Alzheimer’s Disease

Mild-Moderately Severe Stages of Alzheimer’s Disease

Impaired ability to perform challenging mental arithmetic (i.e. counting

backward from 100 by 7s)

Difficulty performing tasks, such as planning dinner for guests, paying

bills or managing finances

Forgetfulness about one's own personal history

Becoming moody or withdrawn,

Be unable to recall their own address, telephone number, high school, etc.

Become confused about where they are or what day it is

Less challenging arithmetic becomes hard (i.e. count back from 20 by 2s)

Need help choosing proper clothing for the season or the occasion

Still remember significant details about themselves and their family

Still require no assistance with eating or using the toilet

Late stages of Alzheimer’s disease

Disorientation

Mood and behavioral changes

Difficulty with speaking, swallowing and walking

Worsening behavioral changes, memory loss, confusion about events,

times, and locations

Unfounded suspicions about family, friends and professional

caregivers

Loss of the ability to converse and respond to the environment

Dependence on others for basic activities of life like bathing, dressing,

eating and using the bathroom.

Inability to communicate and recognize loved ones

Manifestations of the Stages of Alzheimer’s Disease

Alzheimer’s DiseaseAlzheimer’s progresses in stages and at varying rates for

every individual.

Costs of Alzheimer's Disease

Direct

• Health care

• Insurance

• Long term care facility

Indirect

• Home health aide

• Familial support

• Family caregiver

• Stress of caregiver

• Increased health costs of care giver

Alzheimer’s

Costs

Issues experienced by families

and caregivers include:

•Denial

•Anger / Frustration

•Guilt

•Loss and Grief

•Letting Go

•Financial Stress

•Role Reversals

•Social Isolation

Indirect Costs of Alzheimer's Disease

Overall Financial and Healthcare Impact

• The main component of the dementia costs is

for institutional and home-based long-term

care rather than medical services.

• The cost of nursing home care, and formal

and informal home care comprise 75% to

84%of dementia costs.

•People with Alzheimer’s disease and related

dementias have three times as many hospital

stays as do others.

Direct Costs of Alzheimer's Disease

What is it?

• Possible drug treatment for Alzheimer’s

• Cholinesterase inhibitors (ChEIs) slow the

activity of cholinesterase (an enzyme that

decreases the amount of acetylcholine),

making more acetylcholine available for

communication between cells.

Cholinesterase Inhibitor

Why are they important?

• Because a cholinesterase inhibitor slows the

activity of cholinesterase, more acetylcholine is

available.

•When more acetylcholine is available:

• apathy and anxiety can be alleviated

•alertness, motivation, and memory

can be improved

Cholinesterase Inhibitor

The Use of Cholinesterase Inhibitors to

Treat Alzheimer’s Disease

• Cholinesterase inhibitors are NOT a cure for

Alzheimer’s. They do:

•help the damaged regions of the brain function

better, which in turn slows down the emergence of

symptoms and improves your loved one’s quality

of life.

• slow the activity of cholinesterase, making more

acetylcholine available for communication

between cells.

Benefits of the Three Drug Treatment Options

Donepezil(Aricept)

Improves mental function

Improves cognitive benefits to a

level that exceeds the minimum

clinically important difference and

significant functional benefits over

the course of 12 months

Approved to treat all stages of

Alzheimer's disease

Elimination is through the liver

Option #1:

Benefits of the Three Drug Treatment Options

Rivastigmine(Exelon)

Approved to treat mild to moderate

Alzheimer’s disease

Improves cognition, activities of daily

living, and global function.

Has relatively low protein-binding

characteristics hence, it has a minimal

potential to significantly interact with

other drugs.

Option #2:

Benefits of the Three Drug Treatment Options

Galantamine (Razadyne)

Approved to treat mild to moderate

Alzheimer’s disease

Improves cognition, activities of daily

living, and global function.

Inhibits AChE

Modulates nicotinic receptors

Elimination pathway is through the

kidney and liver

Option #3:

Potential Side Effects of the Three

Cholinesterase Inhibitors:

Nausea, vomiting,

diarrhea;

Loss of appetite;

Muscle cramps;

Fatigue

Insomnia black, bloody,

or tarry stools;

• Black, bloody, or tarrystools

• Coughing up blood orvomit that looks like blood

or coffee grounds

•Difficultly urinating• Seizures• Impaired thinking andreactions

Donepezil (Aricept)

Potential Side Effects of the Three

Cholinesterase Inhibitors:

Nausea, vomiting, loss of

appetite,

Joint pain

Dizziness, drowsiness,

tremors

Bradycardia, arrhythmias,

fainting

Increased sweating

Sleep problems

Cough, runny nose,

headache

Black, bloody, or tarry

stools

Severe abdominal pains

Seizures

Pain with urinating

Allergic reactions ( rash,

itching, swelling of the

face/tongue/throat)

Severe dizziness

Confusion, agitation, fear

Rivastigmine(Exelon)

Potential Side Effects of the Three

Cholinesterase Inhibitors:

Feeling tired, dizzy, or

light-headed;

Nausea, vomiting, gas,

loss of appetite;

Weight loss

Headache

Chest pain, slow heart rate

Black, bloody, or tarry stools;

Coughing up blood or vomit

that looks like coffee grounds;

Weakness, confusion,

decreased sweating, extreme

thirst, hot dry skin

Urinating less than usual or

not at all

Galantamine (Razadyne)

Is One Cholinesterase Inhibitor Better? All cholinesterase inhibitors appear to work equally well.

Aricept has been on the market longer and therefore

seems to be prescribed more often.

Potential long-term side effects are

different

If one doesn’t work, try a different

one

There is experimental evidence that switching can often

help, by providing superior efficacy, reducing side effects,

or both (Alzheimer’s Compendium, 2014).

Rationale for Funding Decision

Alzheimer’s disease is the 6th leading cause of death in the US and the 5th leading cause of death in persons aged65 and up.

As the United States’ population ages, the incidence of Alzheimer’s disease will increase

There is a significant increase in deaths from Alzheimer’s disease expected as US age increases.

• Over the next fiveyears, 5% to 15% of

deaths in older people

will be attributed to

Alzheimer’s

Rationale for Funding Decision

• These cholinesterase inhibitors are currently

one of few known ways to simply help the

damaged brain function better than it would

without them.

• While the length of time they are effective is

not specifically known, they have been

proven to improve function in many people

suffering from Alzheimer’s.

While there is still much to be learned about Alzheimer’s

such as:

the exact changes (and their order) that trigger the

development

symptoms, causes, risk factors, and treatment

better understanding of how social and cognitive

engagement may affect biological processes to reduce

the risk of this disease.

We know the public health impact of Alzheimer’s is

significant and the paradigm shift to health promotion calls

for further researchin order toprevent Alzheimer’s disease

Rationale for Funding Decision

ReferencesAlzheimer’s Association, (2013). Alzheimer’s disease facts and figures.

RetrievedFebruary 7, 2014, from http://www.alz.org/downloads/facts_figures_2013.pdf

Alzheimer’s Association, (2014). What is Alzheimer’s? Retrieved fromhttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asp#research

Alzheimer’s Association. (2014). The search for Alzheimer’s causes and risk

factors. Retrieved from http://www.alz.org/research/science/alzheimers_disease_causes.asp

Alzheimer’s Compendium. (2014). Alzheimer’s drugs: Fact and Opinion.

Retrieved from http://www.alzcompend.info/?p=244

Alzheimer’s Society (2014). Leading the fight against dementia. Retrieved

from http://www.alzheimers.org.uk/404.php

Healthcare Professionals Network. (2012). Cognitive benefits with continued donepezil in Alzheimer’s. Retrieved from

http://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimers

Huba, G.J. (2013). #Dementia and “Typical” #Aging: Examples of (Better???)

Ways to Present Online Health Information with #MindMaps. Retrieved fromhttp://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/

http://www.alz.org/downloads/facts_figures_2013.pdfhttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asphttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asphttp://www.alz.org/research/science/alzheimers_disease_causes.asphttp://www.alz.org/research/science/alzheimers_disease_causes.asphttp://www.alzcompend.info/?p=244http://www.alzheimers.org.uk/404.phphttp://www.alzheimers.org.uk/404.phphttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://www.hcplive.com/articles/Cognitive-Benefits-With-Continued-Donepezil-in-Alzheimershttp://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/http://hubaisms.com/2013/11/06/dementia-and-typical-aging-examples-of-better-ways-to-present-online-health-information-with-mindmaps/

ReferencesMayo Clinic. (2011). Diseases and conditions: Alzheimer's still has no

cure, but twodifferent types of drugs can help manage symptoms of the disease. Retrieved fromhttp://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103

Medical News Today, (2013). What is Alzheimer's disease? Causes, symptoms andtreatment. Retrieved from http://www.medicalnewstoday.com/articles/159442.php

Medicine Net. (2013). Rivastigmine - oral, Exelon. Retrieved fromhttp://www.medicinenet.com/rivastigmine-oral/article.htm

Medline Plus. (2014). Donepizil. Retrieved fromhttp://www.nlm.nih.gov/medlineplus/druginfo/meds/a697032.html

Onor, M.L., Trevisiol, M., and Aguglia, E. (2007). Rivastigmine in the treatment of Alzheimer’s disease: an update. Retrieved from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684084/

Wilkinson, D.G., Francis, P.T., Schwam, E., and Payne-Parrish, J. (2004). Cholinesterase inhibitors used in the treatment of Alzheimer's disease: the relationship between pharmacological effects and clinical efficacy. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15132713

http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048103http://www.medicalnewstoday.com/articles/159442.phphttp://www.medicinenet.com/rivastigmine-oral/article.htmhttp://www.medicinenet.com/rivastigmine-oral/article.htmhttp://www.medicinenet.com/rivastigmine-oral/article.htmhttp://www.nlm.nih.gov/medlineplus/druginfo/meds/a697032.htmlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684084/http://www.ncbi.nlm.nih.gov/pubmed/15132713http://www.ncbi.nlm.nih.gov/pubmed/15132713