Alzheimer's Disease Overview and Epidemiology
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What is the initial insult in the amyloid cascade hypothesis related to Alzheimer's disease?

  • Acc accumulation of Aβ (correct)
  • Formation of neurofibrillary tangles
  • Defect in cholinergic neurons
  • Hyperphosphorylation of tau protein

    • What role do acetylcholinesterase enzymes play in the context of amyloid-beta?

  • They inhibit the formation of Aβ plaques.
  • They degrade Aβ fragments into harmless components.
  • They promote the assembly of Aβ by forming complexes. (correct)
  • They facilitate microglial activation to clear Aβ.

    • Which cognitive symptom is associated with Alzheimer's disease?

  • Tremors
  • Gait disturbances
  • Inability to communicate effectively (correct)
  • Depression

    • What is the typical life expectancy after an Alzheimer's Disease diagnosis?

    <p>Four to eight years</p> Signup and view all the answers

    Which of the following is a behavioral sign in the early stages of Alzheimer's disease?

    <p>Apathy</p> Signup and view all the answers

    What is the most common age demographic affected by Alzheimer's Disease?

    <p>People aged 65 and over</p> Signup and view all the answers

    What is the typical age range for the onset of familial Alzheimer's disease?

    <p>Before the age of 60</p> Signup and view all the answers

    Which of the following is NOT a symptom of Alzheimer's Disease?

    <p>Increased physical strength</p> Signup and view all the answers

    What type of neuronal damage is caused by hyperphosphorylated tau protein?

    <p>Disassembly of microtubules</p> Signup and view all the answers

    Which statement correctly describes the progression of Alzheimer's disease?

    <p>Neuroinflammation is associated with neuronal damage and memory decline.</p> Signup and view all the answers

    What role does the amyloid precursor protein (APP) play in Alzheimer's Disease?

    <p>It is the precursor to amyloid plaques.</p> Signup and view all the answers

    What was the first case of Alzheimer's Disease observed by Alois Alzheimer?

    <p>Auguste Deter</p> Signup and view all the answers

    What component is primarily formed when enzymes cut the amyloid precursor protein (APP)?

    <p>Beta-amyloid fragments</p> Signup and view all the answers

    How does the prevalence of Alzheimer's Disease change with age?

    <p>It doubles every five years after 65.</p> Signup and view all the answers

    Which of the following structures are considered hallmarks of Alzheimer's Disease?

    <p>Amyloid plaques and neurofibrillary tangles</p> Signup and view all the answers

    What is the expected global prevalence of Alzheimer's Disease by 2050?

    <p>100 million</p> Signup and view all the answers

    What is the primary function of the apo E4 gene in the context of Alzheimer's Disease?

    <p>It accelerates the progression of the disease.</p> Signup and view all the answers

    Which brain imaging technique is specifically used to identify abnormal protein accumulation in Alzheimer's Disease?

    <p>PET scan</p> Signup and view all the answers

    In the interpretation of MMSE scores, what does a score between 19-23 indicate?

    <p>Mild dementia</p> Signup and view all the answers

    What is the most significant risk factor for developing Alzheimer's Disease?

    <p>Age</p> Signup and view all the answers

    Which assessment is designed to adjust for patients with poor education when evaluating mental status?

    <p>St. Louis University Mental State Examination (SLUMS)</p> Signup and view all the answers

    Which of the following groups might genetic testing be considered mainly for?

    <p>Early-onset Alzheimer's or familial cases</p> Signup and view all the answers

    What range of scores on the Montreal Cognitive Assessment (MoCA) indicates a high level of cognitive function?

    <p>26-30</p> Signup and view all the answers

    What is the purpose of the family questionnaire mentioned in the context of Alzheimer's assessment?

    <p>To gather information about the patient's mental health from families/caregivers</p> Signup and view all the answers

    What was noted about the ENGAGE trial compared to the EMERGE trial?

    <p>ENGAGE showed more rapid decline.</p> Signup and view all the answers

    What factor limited the initial effectiveness of aducanumab in trials?

    <p>Use in more severe stages of disease.</p> Signup and view all the answers

    What was one of the reasons Medicare officials announced for covering aducanumab?

    <p>It must be used in clinical trials.</p> Signup and view all the answers

    What was Biogen’s reason for discontinuing aducanumab development in January 2024?

    <p>Reprioritization of funds.</p> Signup and view all the answers

    What guidelines were lacking when the aducanumab label was first released?

    <p>Stage of disease initiation.</p> Signup and view all the answers

    What medication types are associated with an increased risk for Alzheimer disease?

    <p>Anticholinergics and benzodiazepines.</p> Signup and view all the answers

    What does ARIA stand for in the context of aducanumab's adverse effects?

    <p>Amyloid-Related Imaging Abnormalities.</p> Signup and view all the answers

    What was announced about clinical trial participants receiving aducanumab prior to its discontinuation?

    <p>They had access until May 1, 2024.</p> Signup and view all the answers

    Which of the following is NOT a reasonable treatment goal for managing Alzheimer's Disease (AD) symptoms?

    <p>Eliminating all symptoms of AD</p> Signup and view all the answers

    What is the primary purpose of acetylcholinesterase (AChE) inhibitors in Alzheimer's treatment?

    <p>To inhibit cholinesterase enzymes</p> Signup and view all the answers

    Which drug is classified as an NMDA antagonist used in Alzheimer's treatment?

    <p>Memantine</p> Signup and view all the answers

    Which statement about Aducanumab (Aduhelm) is accurate?

    <p>It was approved in 2021 as an anti-beta-amyloid antibody.</p> Signup and view all the answers

    What is the mechanism of action for Donanemab-azbt?

    <p>To remove amyloid plaques from the brain</p> Signup and view all the answers

    Which drug combination includes both an NMDA antagonist and an AChE inhibitor?

    <p>Namzaric</p> Signup and view all the answers

    For which group of patients are certain Alzheimer's drugs contraindicated due to genetic factors?

    <p>ApoE4 homozygous patients</p> Signup and view all the answers

    What was the average reduction in amyloid plaques achieved by Donanemab at 6 months of treatment in clinical trials?

    <p>61%</p> Signup and view all the answers

    What is one of the primary roles of pharmacists in recognizing cognitive decline?

    <p>Reviewing medication lists for potentially harmful drugs.</p> Signup and view all the answers

    How can pharmacists enhance medication compliance in patients with Alzheimer's disease?

    <p>By implementing easy-open caps and pill organizers.</p> Signup and view all the answers

    What do the newest drugs for Alzheimer disease, such as aducanumab and lecanemab, target?

    <p>Aggregated forms of amyloid.</p> Signup and view all the answers

    What is a limitation of cholinesterase inhibitors and memantine?

    <p>They only help to manage symptoms without affecting progression.</p> Signup and view all the answers

    What should pharmacists actively do regarding dangerous drugs in patients with dementia?

    <p>Identify and eliminate drugs that exacerbate symptoms.</p> Signup and view all the answers

    What unique formulation can help patients with dysphagia take their medications?

    <p>Oral disintegrating tablets and transdermal patches.</p> Signup and view all the answers

    Which of the following roles can pharmacists serve regarding clinical trials for new Alzheimer medications?

    <p>Point patients toward clinical trial enrollment channels.</p> Signup and view all the answers

    What type of relationship allows pharmacists to notice cognitive decline in patients?

    <p>A long-standing pharmacist-patient relationship.</p> Signup and view all the answers

    Study Notes

    Alzheimer's Disease Overview

    • Alzheimer's Disease (AD) was first recognized in 1906 by Dr. Alois Alzheimer.
    • It is an irreversible progressive neurodegenerative disease.
    • Characterized by memory impairment and other cognitive disturbances.
    • Symptoms gradually decline in three key areas: activities of daily living, behavior, and personality, and cognition.
    • Most common cause of dementia in people aged 65 and older.

    Epidemiology of AD

    • AD affects an estimated 1 in 14 people aged over 65 and 1 in 6 people aged over 80.
    • Globally, AD is estimated to affect at least 50 million people.
    • By 2050, the prevalence of AD is expected to reach nearly 100 million globally.
    • The prevalence of AD doubles every five years beyond the age of 65.
    • The fifth-leading cause of death among those aged 65 and older and a leading cause of disability and poor health.
    • Typical life expectancy after an AD diagnosis is four to eight years.

    Pathophysiology of AD

    • Hallmarks: amyloid plaques, neurofibrillary tangles (NFTs), and synaptic and neuronal cell death.
    • Brain atrophy: Shrinking of the brain tissue.
    • Inflammation: The brain's response to damage and injury.
    • Initial sites: The hippocampus and medial temporal lobe are the initial sites affected.

    Amyloid Precursor Protein (APP)

    • APP is the precursor to amyloid plaques.
    • APP sticks through the neuron membrane.
    • Enzymes cut the APP into fragments of protein, including beta-amyloid.
    • Beta-amyloid fragments clump together to form plaques.

    AD Neuropathology

    • Multifactorial (difficult treatment).
    • Accumulation of Aß is the initial insult, leading to abnormal tau phosphorylation and formation of NFTs.
    • Defect in microglial activation, leading to inefficient clearing of Aß.
    • Acetylcholinesterase may promote Aß assembly.
    • Hyperphosphorylated tau damages the cytoskeleton and signal transduction in neurons.
    • This contributes to memory decline and neuroinflammation (neuronal damage and death).

    Pathologies Associated With AD

    • Amyloid deposition (plaques) increases with age.
    • Microglial activation/inflammation increases with age.
    • Neurofibrillary tangles (NFTs) increase with age.
    • Neuronal loss/atrophy increases with age.
    • Symptoms emerge with age.

    Progression of AD

    • The disease progresses through different stages: preclinical AD, mild cognitive impairment due to AD, mild AD, moderate AD, and severe AD.
    • Each stage is characterized by increasing cognitive impairment and affecting different brain regions.

    Characteristics of Alzheimer Dementia

    • Cognitive symptoms, including acalculia, aphasia, apraxia, amnesia, and agnosia.
    • Behavioral symptoms, including depression, apathy, anxiety, delusions, hallucinations, and psychosis.
    • Extrapyramidal symptoms may present, such as gait disturbance, myoclonus, tremor, and urinary incontinence.

    Types of AD

    • Familial AD (Early-onset): Very rare, typically occurs before age 60, and involves gene mutations.
    • Sporadic AD (Late-onset): The most common type, typically occurs after age 60, and is linked to the apo E4 gene.

    Diagnosis of AD

    • Thorough medical history review, physical examinations, and laboratory tests.
    • Brain imaging techniques (MRI or CT scans) help detect structural changes.
    • PET scans can identify abnormal protein accumulation.
    • CSF analysis or genetic testing may be considered for a more accurate diagnosis.

    Risk Factors of AD

    • Modifiable: sedentary lifestyle, poor nutrition, depression, lack of social engagement, low education level, head injury, poor sleep, stress management, hearing loss, smoking, excessive alcohol consumption, hypertension, high cholesterol, and obesity.
    • Unmodifiable: age, female sex, Black, Hispanic, or Native American race, family history of AD, and APOE ε4 carrier status.

    Identifying Warning Signs of AD

    • Memory loss occurs more frequently in individuals with AD and may interfere in everyday activities.
    • Executive function and completing familiar tasks may be difficult.
    • Confusion with time or place occurs more frequently in individuals with AD than in normal aging.
    • Trouble with visual images and spatial relationships happens more frequently in individuals with AD than in normal aging.
    • Difficulty with speaking or writing, and misplacing items.
    • Decreased or poor judgment is more common in individuals with AD.
    • Withdrawal from work or social activities and changes in mood.

    Mental Status Assessment

    • Folstein MMSE: A 30-point scale assessing cognitive function, heavily relying on verbal skills. Higher score indicates better function.
    • St. Louis University Mental Status Examination (SLUMS): A 30-point scale assessing cognitive function, with adjustment for poor education.
    • Montreal Cognitive Assessment (MOCA): A 30-point scale with multiple cognitive domains.
    • Mini-Cog: A quick (2-3 minute) assessment that includes verbal recall and clock drawing; a score of < 3 or < 4 may suggest a need for further evaluation.

    Treatment Goals

    • Maintaining quality of life (QoL).
    • Maximizing function and activities of daily living (ADLs).
    • Stabilizing cognition.
    • Managing behavioral problems.
    • Reducing caregiver distress and burden.

    Drugs to Improve AD Symptoms

    • Donepezil, Rivastigmine, Galantamine, and Memantine are FDA-approved drugs used to treat AD symptoms. 
    • These drugs work by various mechanisms to improve cognitive function, particularly in the earlier stages of the disease.

    FDA-Approved Disease Modifiers

    • Aducanumab (Aduhelm)
    • Lecanemab
    • Donanemab-azbt (Kisunla) 
    • These drugs are being used to target the amyloid plaques and/or other proteins implicated in AD development and progression.

    Aducanumab Controversy

    • FDA approval, even with controversy because of contradictory trial results.
    • Subsequent discontinuation for lack of Medicare funding and health concerns.

    Shared Decision Making

    • Patients and caregivers working with physicians to set goals collaboratively throughout the diagnosis and management of AD.
    • This aims for shared understanding and decision-making to best manage the disease and the associated healthcare challenges.

    Pharmacist Roles for AD

    • Counsel on risk and prevention by educating patients and informing them about conditions and related medications that may increase the risk of AD.
    • Enhance medication compliance, especially as dysphagia may become a problem as the disease progresses. 
    • Educate on available drugs and potential therapies, emphasizing realistic expectations and the limitations of current treatments.
    • Eliminate dangerous drugs that can exacerbate dementia or AD-associated symptoms.
    • Recommend resources, make referrals, and take note of changes in patients that may signal a concern to a physician.
    • Become a dementia-friendly pharmacy to improve patients' quality of life during the progression of AD.

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    Alzheimer's Disease Past Paper PDF

    Description

    This quiz provides an overview of Alzheimer's Disease, including its history, epidemiology, and pathophysiology. Participants will explore key statistics and the impact of this neurodegenerative condition on the elderly population. Test your knowledge on the prevalence, symptoms, and characteristics of Alzheimer's Disease.

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