Chapter Ten
Summary
Alzheimer’s disease (AD) is the most common type of dementia affecting more than 15 million people
worldwide. Approximately 1 in 45 Americans has AD. Dementia with Lewy Bodies is the next most common type
and vascular dementia accounts for about 20% of all dementia. Less common causes of dementia include Pick’s
disease, corticobasal degeneration, progressive supranuclear palsy, Creutzfeldt-Jacob disease, neurosyphils, normal
pressure hydrocephalus, and HIV related dementia.
AD accounts for billions of dollars in direct patient care costs and loss of productivity/employment
worldwide. About 1% of the GNP. As folks are living longer and the number of new cases increases, the health care
costs associated with AD and other forms of dementia will also increase.
Research into AD had demonstrated that several neurotransmission pathways may be involved including
cholinergic, glutamatergic, serotonergic, and dopaminergic. Loss of cholinergic neurons appears to be most
problematic. Acetylcholinesterase inhibitors, which increase intrasynaptic acetylcholine levels, appear to produce
moderate symptomatic improvement in AD patients. Inflammatory processes may also play a role in the disease
progression. The formation of plaque consisting of beta–amyloid may interfere with neuronal functioning.
Good diagnostic and behavioral assessment is necessary to rule-out other disorders or the effects of various
other medications known to cause dementia and delirium. CT and other scans are typically used to rule-out tumors,
hematomas, and hydrocephalus.
Medications used in the treatment of AD and other cognitive disorders really offer no cure per se. They are
best conceptualized as drugs that help to stabilize cognition, and other behaviors of daily living. While cholinesterase
inhibitors such as Cognex, and Aricept slow the progression of AD, they do not stop it. The most common side effect
with these medications is GI upset. Typically Articept is more effective without the heptic toxicity found with Cognex.
Specific Discussion Questions:
1. Explain the various causes of dementia in most older adults.
2. Why is AD such a costly disease?
3. What are the advantages of one AD medication over another?
Possible True/False Questions:
1. Alzheimer’s Disease or AD is the most common type of dementia
2. Alzheimer’s accounts for approximately 80% of all irreversible dementias
3. Vascular dementia accounts for about 20% of all dementias.
4. AD cannot be detected on most scans, but autopsy reveals a deficit in brain presynaptic cholinergic systems.
5. AD may have a genetic/familial pattern.
6. Beta-amyloid can be detected on scans and removed surgically.
7. Untreated syphilis can cause dementia.
8. Providing a controlled/monitored environment for AD patients may help to reduce confusion and agitation.
9. Most medications for AD and dementia are major tranquilizers that reduce dopamine.
10. Most medications used to treat dementia and AD fall into the cholinesterase inhibitor classification.
11. The average cost for caring for an AD patient over his/her lifetime is about $250,000.
12. There are currently several medications that cure AD.
Possible Multiple Choice Questions:
1. AD affects approximately _____ Americans.
a. 1 in 5
b. 1 in 10
c. 1 in 45
d. 1 in 50
2. AD accounts for about ____ of all irreversible dementias.
a. 50%
b. 60%
c. 70%
d. None of these
3. Research suggests that all of the following neurotransmitters have been implicated in AD dementia except:
a. norepinephrine
b. serotonin
c. dopamine
d. acetylcholine
4. Researchers place the total cost of AD worldwide to be more than __.
a. 600 billion
b. 100 billion
c. 85 billion
d. 76 billion
5. The typical dose for a patient taking Aricept is ____ mg.
a. 5-10
b. 10–20
c. 75-100
d. None of these
6. Which of the following medications is a combination of memantine and donepezil?
a. Cognex
b. Aricept
c. Namzaric
d. Exelon
7. Which of the following belongs to a newer class of AD drug that is known as an N-methyl-D-asparate
receptor antagonist?
a. Reminyl
b. Aricept
c. Namenda
d. None of these
8. Common side effects with AD drugs include all of the following except:
a. nausea
b. diarrhea
c. blurred vision
d. vomiting
9. Which of the following has been associated with liver toxicity?
a. tacrine
b. donepezil
c. galantamine
d. memantine
10. Which of the following is a selective inhibitor of MAO?
a. tacrine
b. galantamine
c. rivastigmine
d. None of these
11. Agitated AD patients who also present with psychotic symptoms are often placed on ____:
a. tranquilizers
b. antidepressants
c. benzodiazepines
d. atypical antipsychotics
12. Depressed AD patients would benefit most from ________ type antidepressants.
a. SSRIs or SPARIs
b. SNRIs
c. MAOIs
d. None of these
Alternative Class Assignments and Essay Questions:
1. Compare and contrast the various medications used in the treatment of AD. What advantages/disadvantages
does each offer?
2. While AD cannot be cured, what known and proposed preventative measures and medications have been
found in the research?
3. Describe the typical symptoms demonstrated by a patient with AD. How might these symptoms be managed
with both medications and behavioral intervention?
Case 1 and 2 Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in each case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in each case?
Answer Key to Possible True/False and Multiple Choice Questions
Chapter Ten
Possible True/False Questions:
Multiple Choice Questions: