Management of Alzheimer's Disease Dementia

80 Pages·2017·2.25 MB·English

Management of
Alzheimer’s Disease
Dementia
Andrea Butler, PharmD
Pharmacy Practice Resident
FAMU College of Pharmacy and Pharmaceutical Sciences
Apalachee Center, Inc.
2018

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Disclosure
 I do not have a vested interest in or affiliation with any
corporate organization offering financial support or grant
money for this continuing education program, or any
affiliation with an organization whose philosophy could
potentially bias my presentation.
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OBJECTIVES
 By the end of the presentation the pharmacist should be able to:
 Define dementia and describe the different types of dementia.
 Describe the pathophysiology of Alzheimer’s Disease (AD).
 Recognize and describe the different stages of AD associated with
disease progression.
 Discuss non-pharmacological approaches in managing AD.
 Implement current standard of care for pharmacological
treatment in patients with AD.
 Explain the pharmacists’ role in managing patients with AD.
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OBJECTIVES
 By the end of the presentation the pharmacist technician should
be able to:
 Define dementia and describe the different types of dementia.
 Describe the pathophysiology of AD.
 Identify the different stages of AD associated with disease
progression.
 Recognize brand and generic names of medications used in the
management of AD.
 Explain the pharmacist technicians’ role in interacting with
patients with AD.
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OVERVIEW
 Introduction
 Epidemiology
 Pathophysiology
 Etiology
 Risk Factors
 Clinical Presentation
 Diagnosis
 Treatment
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Patient Case 1: RD
 RD is a 74 year old Hispanic male who was brought to a
psychiatric facility after his wife called the police. RD lives with
his wife, who helps take care of him. One Sunday morning, she
was helping him get dressed for church when he all of a sudden
began screaming “Who are you and where is my wife!!” while
striking her repeatedly with his cane.
 RD has no previous psychiatric hospital admissions and his
medical conditions include hypertension, BPH, and glaucoma.
 While interviewed by the police, RD seemed disoriented and his
statements did not make sense.
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DEMENTIA DEFINED
 DSM-5 Definition of Dementia
 “Significant acquired cognitive impairment in one or more
cognitive domains (e.g. learning and memory, language,
executive function, complex attention, perceptual-motor
function, social cognition) that represents a drastic decline
from previous baseline and interferes with independence in
daily activities.”
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1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),
American Psychiatric Association, Arlington, VA 2013.
INTRODUCTION
 The most common types of dementia include:
 Alzheimer’s disease dementia
 Gradually progressive dementia affecting cognition, behavior, and
functional status
 One of the leading causes of morbidity and mortality in the elderly2
 Accounts for 50-60% of dementia cases in the elderly2
 Vascular dementia
 Dementia caused by damage to the vasculature or impaired blood
flow to the brain
 Risk factors include stroke, hypertension, and diabetes
 Accounts for 20% of all dementia cases3
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INTRODUCTION CONT’D
 Frontotemporal dementia
 Degeneration of the frontal and/or temporal lobes
 Changes in personality, behavior and a progressive deterioration
in language.
 Accounts for 10-20% of all dementia cases4
 Dementia with Lewy bodies (DLB)
 Cognitive dysfunction, visual hallucinations, and Parkinsonism
symptoms
 Average age of onset is 75 years
 Accounts for less than 20% of all dementia cases5
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EPIDEMIOLOGY
 AD is the 6th leading cause of death in the U.S.6
 As of 2017, 5 million individuals were living with AD in the U.S.6
 By 2050, AD is expected to affect 16 million individuals in the
U.S. and > 130 million worldwide6
 In the U.S., the incidence of AD is higher in African Americans
and lowest in Asian descent7
 Currently, AD and other dementias will cost the nation $259
billion, but is expected to rise as high as $1.1 trillion by 20506
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