Dr. Adeniyi Mofoluwake and Stacy Kramer

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1 Dr. Adeniyi Mofoluwake and Stacy Kramer

2 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 over time and becomes severe enough to interfere with one s daily activities.

3 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

4 Increasing age Unavoidable Risk Factors 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

5 Stages of Alzheimer s disease There 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.

6 Stages of Alzheimer s Mind Map Image courtesy of G.J. Huba (2013).

7 Manifestations of the Stages of Alzheimer s Disease Early 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

8 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

9 Manifestations of the Stages of Alzheimer s Disease 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

10 Alzheimer s Disease Alzheimer s progresses in stages and at varying rates for every individual.

11 Costs of Alzheimer's Disease Alzheimer s Costs Direct Indirect Health care Insurance Long term care facility Home health aide Familial support Family caregiver Stress of caregiver Increased health costs of care giver

12 Indirect Costs of Alzheimer's Disease Issues experienced by families and caregivers include: Denial Anger / Frustration Guilt Loss and Grief Letting Go Financial Stress Role Reversals Social Isolation

13 Direct 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.

14 Cholinesterase Inhibitor 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.

15 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

16 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.

17 Benefits of the Three Drug Treatment Options Option #1: 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

18 Benefits of the Three Drug Treatment Options Option #2: 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.

19 Benefits of the Three Drug Treatment Options Option #3: 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

20 Potential Side Effects of the Three Cholinesterase Inhibitors: Donepezil (Aricept) Nausea, vomiting, diarrhea; Loss of appetite; Muscle cramps; Fatigue Insomnia black, bloody, or tarry stools; Black, bloody, or tarry stools Coughing up blood or vomit that looks like blood or coffee grounds Difficultly urinating Seizures Impaired thinking and reactions

21 Potential Side Effects of the Three Cholinesterase Inhibitors: Rivastigmine(Exelon) Nausea, vomiting, loss of appetite, Joint pain Dizziness, drowsiness, tremors Bradycardia, arrhythmias, fainting Increased sweating Sleep problems Cough, runny nose, 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

22 Potential Side Effects of the Three Cholinesterase Inhibitors: Galantamine (Razadyne) 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

23 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).

24 Rationale for Funding Decision Alzheimer s disease is the 6 th leading cause of death in the US and the 5 th 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 five years, 5% to 15% of deaths in older people will be attributed to Alzheimer s

25 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. 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.

26 Rationale for Funding Decision 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

27 References Alzheimer s Association, (2013). Alzheimer s disease facts and figures. Retrieved February 7, 2014, from Alzheimer s Association, (2014). What is Alzheimer s? Retrieved from Alzheimer s Association. (2014). The search for Alzheimer s causes and risk factors. Retrieved from Alzheimer s Compendium. (2014). Alzheimer s drugs: Fact and Opinion. Retrieved from Alzheimer s Society (2014). Leading the fight against dementia. Retrieved from Healthcare Professionals Network. (2012). Cognitive benefits with continued donepezil in Alzheimer s. Retrieved from 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-

28 References Mayo Clinic. (2011). Diseases and conditions: Alzheimer's still has no cure, but two different types of drugs can help manage symptoms of the disease. Retrieved fromhttp:// Medical News Today, (2013). What is Alzheimer's disease? Causes, symptoms and treatment. Retrieved from Medicine Net. (2013). Rivastigmine - oral, Exelon. Retrieved from Medline Plus. (2014). Donepizil. Retrieved from Onor, M.L., Trevisiol, M., and Aguglia, E. (2007). Rivastigmine in the treatment of Alzheimer s disease: an update. Retrieved from 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

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