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Alzheimer Disease Cheat Sheet (DRAFT) by

Alzheimer Disease Alzheimer DiseaseAlzheimer DiseaseAlzheimer DiseaseAlzheimer Disease

This is a draft cheat sheet. It is a work in progress and is not finished yet.


• Cortical atrophy and loss of neurons

Risk Factors

Age: prevalence doubles for every decade after age 60
Family history: genetic mutations
Gender: more common in women
Exposures: head trauma, high choles­terol, lack of mental stimul­ation


• Neurof­ibr­illary tangles and amyloid plaques
• Amyloid plaques form from imbalance of production and removal of amyloid beta
• Decreased cholin­ergic transm­ission
o Decreased acetyl­choline production
• Results in the noticeable atrophy


Alzheimer disease has also been described using four words that begin with A:
• Loss of short-term memory
• Difficulty with language
• Behavioral changes
• 7 stages of progre­ssive degene­rative changes


• Related to declining cognitive function
• Bowel and bladder incont­inence
• Depression
• Falls [hip fractures @ high risk]
• Infections
• Malnut­rition and dehydr­ation [forge­tting to eat & drink]


• Not definitive until after death
  Requires a brain biopsy or autopsy
Presum­ptive diagnosis based on:
  Review of symptoms with patient and family
  Cognitive tests (MMSE, mini-cog, etc.)
  Imaging: CT, MRI, PET
  To rule out other pathology


• No definitive treatment or cure
• Medica­tions may slow progre­ssion
• Other meds to control some symptoms (depre­ssion, sleep distur­bances, agitation)

Stages of Alzheimer Disease Progre­ssion

Precli­nical: changes in brain that do not result in noticeable signs/­sym­ptoms
Stage 1 (mild) detected w/ screening tool
Stage 2 (moderate) pronounced changes
Stage 3 (Severe)

• Precli­nical

changes in brain that do not result in noticeable signs/­sym­ptoms
o can last for years

Stage 1 (mild)

Can be detected w/ the use of screening tools
o Coming up with the right word or name.
o Rememb­ering names when introduced to new people.
o Having difficulty performing tasks in social or work settings.
o Forgetting material that was just read.
o Losing or misplacing a valuable object.
o Experi­encing increased trouble with planning or organi­zing.
o If identi­fied, this is the stage where they should be placing things in order in the event it progresses fast
 Financial situation, POA, medical direct­ives, living situation, etc.

Stage 2 (moderate)

o Being forgetful of events or personal history.
o Feeling moody or withdrawn, especially in socially or mentally challe­nging situat­ions.
o Being unable to recall inform­ation about themselves like their address or telephone number, and the high school or college they attended.
o Experi­encing confusion about where they are or what day it is.
o Requiring help choosing proper clothing for the season or the occasion.
o Having trouble contro­lling their bladder and bowels.
o Experi­encing changes in sleep patterns, such as sleeping during the day and becoming restless at night.
o Showing an increased tendency to wander and become lost.
o Demons­trating person­ality and behavioral changes, including suspic­iou­sness and delusions or compul­sive, repetitive behavior like hand-w­ringing or tissue shredding.

Stage 3 (Severe)

o Require around­-th­e-clock assistance with daily personal care.
o Lose awareness of recent experi­ences as well as of their surrou­ndings.
o Experience changes in physical abilities, including walking, sitting and, eventu­ally, swallowing
o Have difficulty commun­ica­ting.
o Become vulnerable to infect­ions, especially pneumonia.

Drugs Used to Treat Alzheimer Disease


Cholin­est­erase Inhibitors

Prototype: Donepezil
prevent the breakdown of the neurot­ran­smitter acetyl­choline
o Reversible cholin­est­erase inhibitor that causes elevated levels of acetyl­choline (ACh) in the cerebral cortex which slows the neuronal degrad­ation of Alzheimer disease
o Not a cure it ONLY improves cognition & memory
o Slows effects of Alzhei­mer’s but will NOT stop the disease
o Adverse effects: insomnia, fatigue, rash, N/V/D, dyspepsia, abdominal pain, muscle cramps

N-Meth­yl-­D-a­spa­rtate (NMDA) Antagonist

Protype: Memantine
o Memantine is used to treat modera­te-­to-­severe Alzhei­mer's disease, especially for people who are intolerant of or have a contra­ind­ication to cholin­est­erase inhibitors
o A dysfun­ction of glutam­atergic neurot­ran­smi­ssion, manifested as neuronal excito­tox­icity, is hypoth­esized to be involved in the etiology of Alzheimer disease.
Adverse effects:

o Confusion
o Dizziness
o Drowsiness
o Headache
o Insomnia
o Agitation
o Halluc­ina­tions
o Less common adverse effects include vomiting, anxiety, hypert­onia, cystitis, and increased libido.
antago­nizes (inhibits) NMDA (gluta­mate) receptors