alzheimer and dementia, Slides of Psychology

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ALZHEIMER'S &

DEMENTIA

PHARMACY

INTERVENTION

BY: WESTERN UNIVERSITY OF HEALTH SCIENCES

OBJECTIVES

• (^) Define Alzheimer’s disease and dementia, and

understand the requirements for diagnosis

• (^) Recognize the neuropathology and neurotransmitters

involved

• (^) Discuss the pharmacokinetics and pharmacodynamics

in the geriatric population

• (^) Be able to assess a patient with or suspected to have

Alz and dementia, and make recommendations to

optimize therapy

TYPES OF DEMENTIA

• (^) Mild Cognitive Impairment (MCI)
• (^) Alzheimer’s Disease (AD)
• (^) Vascular Dementia
• (^) Lewy Body Dementia
• (^) Frontal Lobe dementia
• (^) Mixed Dementia

• (^) Dementia is a collection of symptoms related to cognitive decline
• (^) Can include cognitive, behavioral and psychological symptoms
• (^) Due to biological changes in the brain
• (^) Alzheimer’s is most common cause
• (^) Mixed dementia is very prevalent
• (^) Some causes of cognitive decline are reversible and not truly dementia Alzheimer’s 60%-80% Vascular 10%-40% Lewy Bodies 10%-25% Frontotemporal ~10% Mixed Dementia = > 1 Neuropathology Prevalence ~50%

Dementia

An ‘umbrella’ term used to describe a range of symptoms associated with cognitive impairment DEMENTIA IS A SYNDROME

DEFINITION

• (^) According to the Diagnostic and Statistical Manual of Mental Disorders-IV-TR - (^) Multiple cognitive deficits - Memory impairment plus one or more: - (^) Aphasia - (^) Apraxia - (^) Agnosia - (^) Dysfunction is executive functioning - Deficits must be severe enough to cause impairment in occupational and/or social functioning

EPIDEMIOLOGY

• Dementia
  • Prevalence
    • (^) Higher in women than men
    • (^) Static's vary depending on the source
      • 3.0% with MCI in adult population
      • 1.4-1.6% for ages 65-69 to 16-25% over age 85
  • Alzheimer’s Disease
    • (^) 5.3 million people have AD
    • (^) 7th leading cause of death
    • (^) $172 billion dollars in annual costs
    • 10.9 million unpaid caregivers

NEUROPATHOLOGY IN

BRIEF

• AD

• (^) B-amyloid plaques
  • (^) Leads to neuronal death
• (^) Neurofibrillary tangles
  • (^) Abnormal neurons die and form tangles
• Inflammation processes lead to neuronal death and plaque formations
• (^) VaD
• (^) Disruptions of blood flow to different structures in the brain responsible for cognition, executive functioning and behavior

NEUROCHEMICAL

DISRUPTIONS

• (^) Cholinergic Systems
  • (^) Plaque formations damage cholinergic neurons and result in decrease in cognition and memory
• (^) Glutamatergic System
  • (^) Plaque aggregation disrupts transmission of glutamate which results in stimulation of NMDA - (^) This can lead to excitotoxicity and neuronal death

DIFFERENTIAL

DIAGNOSIS

• (^) Delirium
  • Sudden alterations in cognition
  • (^) Fluctuations throughout the day
  • (^) Impaired attention span
  • (^) Disturbances in sleep-wake cycle and psychomotor activity
  • Maybe due to medical condition or medications
• (^) Other psychiatric disorder
  • (^) Mood disorder
• (^) Substance abuse and or withdrawal

PHARMACOLOGY IN

GERIATRICS

• (^) Medication use in geriatrics
  • (^) 35% of all prescriptions dispensed
  • (^) 50% of all OTC medications
• Polypharmacy
  • (^) 4-5 medications
  • (^) At least 2 OTC medications regularly
• (^) In 2020, estimates
  • (^) 106,000 deaths from medication errors
  • Annual cost of $85 billion

GERIATRIC

PHARMACODYNAMICS

• (^) Dopaminergic
  • Decreased D receptors in striatum
• (^) Serotonergic
  • (^) Decreased nerve terminals and transporters
• (^) Cholinergic system
  • (^) Decreased choline acetyltransferase and cholinergic cells - (^) Gaba-ergic system - (^) Potential increase in response to potentiation at GABA receptors - (^) Adrenergic system - (^) Impaired baroreceptor function may result in orthostasis

PRESCRIBING IN

GERIATRICS

• (^) Complete and thorough medication reconciliation
• (^) Reduce polypharmacy
• (^) Appropriate dosing and drug selection
• (^) Utilizing pharmacists for consultation and effective communication/education
• (^) Medication education focused on compliance and adherence

DRUG INTERACTIONS

• (^) Occur when the effectiveness or toxicity of a drug is altered by the concomitant administration of another drug
• (^) 3 classifications of drug interactions
  • (^) Pharmaceutic
    • (^) Physical or chemical incompatibility
  • (^) Pharmacodynamic
    • (^) Addition, synergism or antagonism of each drug’s effect
  • (^) Pharmacokinetic
    • (^) Changes in blood levels of the object drug

MEDICATIONS IN

DELIRIUM

• Many drugs are suspect in delirium or cognitive impairment cases
  • (^) Psychoactive meds suspect in 15-75% of cases
  • (^) Identified as definite cause in only 2-14%
• (^) There are not many well designed studies examining drug-induced delirium
  • The studies have conflicting results, vary in design and analysis
  • (^) Benzodiazepines and antipsychotics noted significant results in few studies
  • (^) Anticholinergics, anticonvulsants, antidepressants, antiemetics, antiparkinsonians, corticosteroids, H-2 antagonists, and NSAIDs were not significantly associated with delirium
• (^) Critical review conclusions: the current evidence of an association of specific medications and delirium is rather weak.