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alzheimer and dementia, Slides of Psychology

powerpoint on dementia and alzheimer

Typology: Slides

2017/2018

Uploaded on 06/19/2023

melissa-nursing
melissa-nursing 🇺🇸

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ALZHEIMER'S &
DEMENTIA
PHARMACY
INTERVENTION
BY: WESTERN UNIVERSITY OF HEALTH SCIENCES
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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.