Updated: 10/6/2021

Alzheimer's Disease Drugs

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Snapshot
  • A 65-year-old man is brought by his daughter to the neurologist for the management of his recently diagnosed Alzheimer's dementia. The daughter reports foregetfulness at times and has noticed few instances where he was confused in familiar places. She denies any major changes in his personality or hallucinations. The patient was started on donepezil for the patient's mild Alzheimer's  dementia.
Introduction
  • A neurodegenerative disorder that is the most common cause of dementia
    • etiology is unknown; however certain genetic mutations have been described
    • decreased acetylcholine (ACh) appears to be associated with Alzheimer's disease
      • ACh appears to be involved in memory
      • choline acetyltransferase activity—involved in ACh synthesis—seems to be decreased in the cerebral cortex, hippocampus, and amygdala in patients with Alzheimer's disease
  • Acetylcholinesterase inhibitors 
    • donepezil, rivastigmine, and galantamine 
      • increases ACh concentration
      • can be used for mild-to-moderate Alzheimer's
      • improve symptoms but not prognosis 
    • toxicity
      • nausea, dizziness, and insomnia
  • N-methyl-D-aspartate (NMDA) receptor antagonist
    • memantine 
      • can be used for moderate-to-severe Alzheimer's
      • believed to decrease intracellular calcium accumulation to aid in the prevention of excitotoxic neuronal damage 
      • toxicity
        • commonly is dizziness, headache, and confusion

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Questions (1)

(M1.NE.17.4822) A 70-year-old woman is brought to her physician by her daughter who reports that the patient has been increasingly confused and forgetful over the past year. The daughter reports that the patient has difficulty finding words, remembering names, and maintaining a conversation. She has gotten lost twice while driving. Her past medical history is known for obesity, diabetes, and atrial fibrillation. She takes metformin, glyburide, and warfarin. She drinks socially and has a 30 pack-year smoking history. Her family history is notable for Parkinson’s disease in her father and stroke in her mother. A head CT demonstrates sulcal widening and narrowing of the gyri. The physician decides to start the patient on a medication known to inhibit a cell surface glutamate receptor. Which of the following is a downstream effect of this medication?

QID: 109424
1

Decreased intracellular calcium

31%

(49/159)

2

Increased intracellular calcium

11%

(17/159)

3

Increased intracellular sodium

8%

(13/159)

4

Increased intracellular acetylcholine

35%

(55/159)

5

Decreased intracellular acetylcholine

14%

(23/159)

M 1 C

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