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 millions of dollars in direct patient care costs and loss of productivity/employment. 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.
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?
4. Why is environment so important in patients with AD and other dementias?
5. In addition to the various types of prescription medications used in the treatment of AD, what other
substances are used to reduce symptoms or reduce the occurrence of the disease?
Possible True/False Questions:
1. Alzheimer’s Disease or AD is the most common type of dementia
2. Alzheimer’s accounts for approximately 75% 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. Form of dementia may be caused by vitamin deficiencies.
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.
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 approximate annual cost of AD in the US to be about __.
a. 65 billion
b. 67 billion
c. 69 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 may be more helpful for patients with Lewy Bodies dementia?
a. Cognex
b. Aricept
c. Namenda
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
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?
4. Explain the various causes of dementia/delirium in patients with cognitive disorders.
5. What types of medications may be used to reduce agitation in an AD patient?
6. What types of medications may be used to reduce psychotic symptoms?
7. Explain how depression may be a factor in dementia patients.
8. What medications are most helpful in depressed AD patients?
9. Explain why Neurontin, Lamictal, or Topamax may be better choices than Tegretol for the AD patient.
10. Explain the glutamate excitotoxicity hypothesis.
Read the Case Vignette in this chapter and answer the following questions:
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in the case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in this case?
4. Any other medications that might be considered…what is the rationale?
5. If you were asked to follow-up on this case as the treating therapist, would you offer any additional
suggestions or approaches?
Chapter Ten
Answer Key
True/False Questions:
Possible Multiple Choice Questions: