Alzheimer's Disease Overview
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Which of the following best describes Alzheimer's disease?

  • Loss of cognitive function primarily due to stroke.
  • A mental disorder characterized by acute confusion.
  • A type of reversible cognitive impairment.
  • A type of progressive dementia with no known cause. (correct)

    • What is a distinguishing feature of dementia of the Alzheimer type?

  • Excessive production of serotonin.
  • Massive increase in cholinergic neurons.
  • Reduction of dopamine receptors.
  • Neurofibrillary tangles. (correct)

    • What is the primary neurotransmitter affected in Alzheimer's disease?

  • Acetylcholine (correct)
  • Serotonin
  • GABA
  • Dopamine

    • Which of the following drugs is NOT a centrally acting cholinesterase inhibitor?

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

    What is the main therapeutic goal of using acetylcholinesterase inhibitors in Alzheimer's disease?

    <p>To enhance cholinergic neurotransmission.</p> Signup and view all the answers

    Why is the use of drugs for Alzheimer's disease described as palliative?

    <p>They do not halt the neurodegenerative process.</p> Signup and view all the answers

    What is the significance of NMDA-glutamate receptors in Alzheimer's treatment?

    <p>They are targeted to prevent excitotoxicity.</p> Signup and view all the answers

    What is the first centrally acting cholinesterase inhibitor approved for the treatment of Alzheimer's disease?

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

    What are common symptoms of multiple sclerosis (MS)?

    <p>Weakness and bladder problems</p> Signup and view all the answers

    What is the purpose of prednisone in treating MS?

    <p>To reduce the duration of exacerbations</p> Signup and view all the answers

    Which type of MS medication is Interferon β-1b classified as?

    <p>Disease-modifying therapies</p> Signup and view all the answers

    How does Interferon β-1b affect lymphocytes in MS treatment?

    <p>It reduces the secretion of interferon-γ.</p> Signup and view all the answers

    What characterizes the relapsing-remitting form of MS?

    <p>Periods of symptom exacerbation and remission</p> Signup and view all the answers

    What is a key effect of the immuno-modulatory properties of Interferon β-1b?

    <p>Reduces inflammatory responses</p> Signup and view all the answers

    Which of the following statements is true about the chronic nature of MS?

    <p>MS can exhibit periods of remission.</p> Signup and view all the answers

    What potential benefit does Interferon β-1a provide for patients with MS?

    <p>Decrease in the number of new lesions detected by MRI</p> Signup and view all the answers

    What is the primary mechanism of action of memantine in Alzheimer's disease?

    <p>It acts as a low potency NMDA receptor antagonist.</p> Signup and view all the answers

    Which of the following is a common adverse effect associated with drugs used for Alzheimer's disease?

    <p>Nausea and diarrhea</p> Signup and view all the answers

    What is the purpose of caprylidene in the treatment of Alzheimer's disease?

    <p>It provides the brain with ketone bodies for energy.</p> Signup and view all the answers

    Which statement best describes the action of NMDA-glutamate receptor antagonists?

    <p>They help prevent loss of neurons from excitotoxic damage.</p> Signup and view all the answers

    What is the significance of the combination drug Namzaric?

    <p>It enhances the efficacy and compliance in Alzheimer treatment.</p> Signup and view all the answers

    In the context of Alzheimer's disease, what role does excess intracellular Ca2+ play?

    <p>It leads to programmed cell death.</p> Signup and view all the answers

    How does age-related glucose uptake affect patients with Alzheimer's disease?

    <p>It impairs the brain's preferred energy source.</p> Signup and view all the answers

    What type of condition is multiple sclerosis classified as?

    <p>An autoimmune inflammatory demyelinating disease</p> Signup and view all the answers

    What is a primary function of Glatiramer in treating multiple sclerosis?

    <p>It acts as a decoy to T-cell attacks on myelin.</p> Signup and view all the answers

    Which of the following is a possible adverse effect of Peginterferon β-1a?

    <p>Flu-like symptoms.</p> Signup and view all the answers

    What is the mechanism of action of Fingolimod?

    <p>It prevents lymphocytes from leaving lymph nodes.</p> Signup and view all the answers

    Why should Teriflunomide be avoided in pregnant women?

    <p>It can cause fetal toxin exposure.</p> Signup and view all the answers

    What is a common adverse effect of Dimethyl fumarate?

    <p>Elevated liver enzymes.</p> Signup and view all the answers

    What does the PEGylation process achieve in Peginterferon β-1a?

    <p>Provides a longer duration of action.</p> Signup and view all the answers

    Which aspect of Teriflunomide's action relates to immune cell activity?

    <p>Reduces proliferation of overactive immune cells.</p> Signup and view all the answers

    What is an effect associated with the first dose of Fingolimod?

    <p>First-dose bradycardia.</p> Signup and view all the answers

    What is the estimated lifespan following an ALS diagnosis?

    <p>2 to 5 years</p> Signup and view all the answers

    Which drug is known for its role in managing ALS by potentially prolonging survival time?

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

    Which mechanism best describes how Riluzole functions in ALS treatment?

    <p>Inhibits glutamate release and blocks sodium channels</p> Signup and view all the answers

    What is the primary characteristic of Edaravone in the treatment of ALS?

    <p>It functions as a free radical scavenger and antioxidant</p> Signup and view all the answers

    Which medication is specifically indicated for controlling spasticity associated with neurological diseases like MS and ALS?

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

    What is one of the effects of Baclofen when used to treat muscle spasticity?

    <p>Reduces motor neuron excitability</p> Signup and view all the answers

    Which of the following statements about Gabapentin is correct?

    <p>It is indicated for slowing the decline in muscle strength.</p> Signup and view all the answers

    What important aspect of ALS treatment involves symptomatic management?

    <p>Improving quality of life through symptom relief</p> Signup and view all the answers

    Study Notes

    Alzheimer's Disease

    • Alzheimer's disease (AD) is a progressive dementia with no known cause or cure.
    • It is a common age-related dementia distinct from vascular dementia caused by brain infarction, stroke, trauma or alcohol.
    • AD is associated with brain shrinkage and localized loss of neurons, primarily in the hippocampus and basal forebrain.
    • AD has a devastating impact on patients and families due to its effects on cognitive, emotional, and physical function.

    Features of Alzheimer's Disease

    • AD has three distinguishing features:
      • Accumulation of senile plaques (β-amyloid accumulations)
      • Formation of numerous neurofibrillary tangles
      • Loss of cortical neurons, particularly cholinergic neurons
    • Patients with AD have a deficit in cholinergic neurotransmission due to the destruction of neurons producing acetylcholine.
    • Pharmacologic interventions for AD are palliative and provide modest short-term benefit.

    Treatment Goals

    • Current therapies for AD aim to:
      • Improve cholinergic transmission within the CNS
      • Prevent excitotoxic actions resulting from overstimulation of NMDA-glutamate receptors

    Acetylcholinesterase Inhibitors

    • Donepezil, Galantamine, Rivastigmine, and Tacrine are examples of acetylcholinesterase inhibitors.
    • These drugs are used to improve cholinergic neurotransmission in the affected areas of the brain.
    • While they may slow cognitive deterioration, they don't affect the underlying neurodegenerative process.

    Tacrine (Cognex®)

    • The first centrally acting cholinesterase inhibitor approved for AD treatment.
    • Slows the progression of AD.
    • Common adverse effects include nausea, diarrhea, vomiting, anorexia, tremors, bradycardia, and muscle cramps.

    Memantine (Namenda®)

    • An NMDA-glutamate receptor antagonist approved for AD treatment.
    • It works by attenuating the excitotoxic effects of glutamate, implicated in neuronal loss in AD.
    • It is excreted largely unchanged.
    • Namzaric®, a combination of memantine extended-release and donepezil, is available.

    Caprylidene (Axona®)

    • A medical food metabolized into ketone bodies, which the brain can use for energy when glucose processing is impaired.
    • MRI scans of the elderly and those with AD reveal decreased glucose uptake, the brain's preferred energy source.
    • Caprylidene aims to replace depleted glucose levels for patients with age-associated memory impairment and AD.

    Multiple Sclerosis (MS)

    • An autoimmune inflammatory demyelinating disease of the CNS with variable course.
    • Demyelination disrupts nerve transmission, leading to inflammation and plaque formation in the brain and spinal cord.

    MS Symptoms & Treatment

    • Symptoms include pain, spasticity, weakness, ataxia, fatigue, and problems with speech, vision, gait, and bladder function.
    • Many patients experience relapses and remissions, but some have progressive disease.
    • Acute exacerbations are treated with prednisone, which shortens exacerbations and ameliorates symptoms.
    • Prednisone is administered orally in milder cases and parenterally in more severe cases.

    Disease-Modifying Therapies

    • Drugs approved for MS aim to reduce relapse rates and prevent disability accumulation.
    • These medications modify the immune response by inhibiting white blood cell-mediated inflammatory processes that damage myelin sheaths.

    Interferon β-1b & Interferon β-1a (Betaseron®)

    • Interferon β-1b was the first drug to demonstrate the ability to halt and even reverse the progression of MS.
    • It reduces inflammatory responses that lead to demyelination.
    • Clinical studies showed it reduced relapse frequency and new lesions in patients with relapsing-remitting MS.

    Interferon β-1b Mechanism of Action

    • Increases natural killer cell cytotoxicity and macrophage phagocytic activity.
    • Reduces interferon-γ secretion by activated lymphocytes, which may halt MS progression.

    Interferon β-1a

    • Approved for relapsing MS and is a synthesized recombinant protein.
    • Peginterferon β-1a, a PEGylated derivative, provides longer action.
    • Adverse effects may include depression, injection site reactions, hepatic enzyme elevations, and flu-like symptoms.

    Glatiramer (Copaxone®)

    • A synthetic polypeptide mimicking myelin basic protein, a component of myelin sheaths.
    • May act as a decoy to T-cell attack.
    • Clinical trials showed reduced relapse episodes compared to placebo.
    • Post-injection reactions with flushing, chest pain, anxiety, and itching can occur.

    Fingolimod (Gilenya®)

    • An oral drug that alters lymphocyte migration, reducing their presence in the CNS.
    • Used for relapsing MS patients.
    • Exact mechanism unknown, but it is a sphingosine-1-phosphate receptor modulator.
    • Prevents lymphocyte egress from lymph nodes, lowering peripheral blood levels and reducing CNS lymphocyte migration.
    • May cause first-dose bradycardia and increased risk of infection and macular edema.
    • Siponimod and Ozanimod are similar drugs on the market.

    Teriflunomide (Aubagio®)

    • A pyrimidine synthesis inhibitor used to treat relapsing MS.
    • Reduces proliferation and concentration of active lymphocytes in the CNS.
    • May elevate liver enzymes and cause hepatic toxicity.
    • Avoid during pregnancy.

    Dimethyl Fumarate (Tecfidera®)

    • Oral drug for relapsing MS that reduces oxidative stress to diminish disease progression.

    Amyotrophic Lateral Sclerosis (ALS)

    • Characterized by muscle wasting, weakness, respiratory failure, and death within 2-5 years.
    • Cause is unknown but involves a defect in superoxide dismutase, an enzyme that scavenges superoxide radicals.
    • Treatment for ALS is largely symptomatic.
    • Riluzole and Edaravone are indicated for ALS management.
    • Baclofen and Gabapentin are used to control spasticity.

    Riluzole (Rilutek®)

    • The first drug approved for ALS treatment.
    • Exact mechanism of action unclear, but it is an NMDA receptor antagonist and may inhibit glutamate release and sodium channels.
    • May improve survival time in ALS patients.
    • Prolongs time before tracheotomy and extends life by approximately 3 months.

    Edaravone (Radicava®)

    • A neuroprotective agent that reduces neuronal damage due to oxidative stress, potentially slowing ALS progression.
    • FDA-approved for ALS treatment.

    Anti-Spastic Agents for MS & ALS

    • Used to treat skeletal muscle spasms that may occur from injury or neurological diseases.
    • Physical therapy is used for spasticity, but anti-spastic drugs may be helpful in severe cases.

    Baclofen (Lioresal®)

    • A GABAB receptor agonist that reduces motor neuron excitability.
    • Useful for reducing MS-related spasticity, particularly flexor spasms, pain, clonus, and muscle rigidity.

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    Description

    This quiz covers essential information about Alzheimer's disease, including its distinguishing features, effects on the brain, and treatment goals. Explore the characteristics of this progressive dementia and its impact on patients and families.

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