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    AnejoHe

    althCommunications

    Margaret Bray

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    Margaret Bray

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    // Pocket Guide to Alzheimers Disease

    Table of Contents

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    Treating Alzheimers Disease. Cholinesterase Inhibitors. NMDA Receptor Antagonist, MemantineTreatment of Associated Conditions

    .Treatments for Behavioral Symptoms.Treating Sleep Problems.Alternative Therapies. Ginkgo Biloba.Vitamin E

    . Fatty Acids and Lipids. Omega-3 fatty acids. Caprylic Acid and Coconut oil. Phosphatidylserine

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    // Pocket Guide to Alzheimers Disease

    IntroductionAlzheimer disease (AD) is the most common cause of dementia in

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    three copies rather than two. Indeed, many individuals with Downs

    syndrome develop Alzheimer's disease, often as young as their 30s and 40s.It has also been shown that people with the apolipoprotein E4

    (ApoE4) gene (approximately 1 in 7 of the population in the US) are

    at higher risk for developing Alzheimer's disease. It is believed ApoE4

    attaches itself to a brain cell receptor, that in turn attaches to APP, and

    is carried into the brain cell, where proteases breakdown APP producingprotein fragments (beta-amyloid) that are believed to be the start of

    the cause of degeneration and death of neurological tissue, and the

    manifestation of the characteristics of Alzheimers disease. Research

    is ongoing to identify further possible routes and causes of the disease.

    Healthy Neuron

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    // Pocket Guide to Alzheimers Disease

    In 1901 Alois Alzheimer described what we now believe to be

    Alzheimers disease in a 51-year-old woman named Auguste Deter.

    Alzheimer diagnosed Deter with presenile dementia, which today

    It was in 1906 that a German physician, Alois Alzheimer, recorded

    brain cell abnormalities while performing an autopsy on a patient whohad died after years of severe memory problems, confusion and difficulty

    understanding questions. While performing a brain autopsy, Alzheimer

    noted dense deposits surrounding the nerve cells (neuritic plaques)

    and inside the nerve cells he observed twisted bands of fibers (neurofibrillary

    tangles). Today, when these plaques and tangles are found during autopsythere is certain diagnosis of Alzheimer's disease. Despite knowledge

    of the underlying pathology, treatments that directly target the underlying

    molecular pathways and halt the brain degeneration, specifically the formation

    of plaques and tangles, have still to be identified, although progress has

    been made in this field (2010 Progress Report on Alzheimers Disease).

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    8/28More recent tissue section showing plaques and tangles

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    // Pocket Guide to Alzheimers Disease

    Today the only approved treatments for Alzheimers are those thathave an indirect effect through the slowing of cognitive decline by aiding

    neurotransmission. These drugs include the cholinesterase inhibitors

    (donepezil, galantamine and rivastigmine), whose mode of action is

    to make more acetylcholine available for neural communication processes

    in otherwise deteriorating cells, and the N-methyl-D-aspartate(NMDA) receptor antagonist, memantine. These drugs do not delay

    or halt progression of the disease, but help to maintain neurotransmission

    across brain cells, provide temporary symptomatic relief and may slow

    symptoms of cognitive decline in mainly in the earlier stages of

    Alzheimers disease.

    In this book we describe as much as possible that is known about

    Alzheimers disease today, from the possible causes and risk factors,

    through diagnosis, treatments and advances in the understanding of

    the disease.

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    // Pocket Guide to Alzheimers Disease

    There is no single test that can show whether a person has Alzheimer's.

    Furthermore, it has become increasingly evident that the signs and

    Diagnostic TestsDiagnosis

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    Sample MMSE questions

    1. Orientation to time: 'What is the date?'

    2. Registration: 'Listen carefully. I am going to say three words. You

    say them back after I stop. Ready? Here they are... apple [pause], penny

    [pause], table [pause]. Now repeat those words back to me.' [Repeat

    up to 5 times, but score only the first trial.]3. Naming: 'What is this?' [Point to a pencil or pen.]

    4. Reading: 'Please read this and do what it says.' [Show examinee the

    following words on the stimulus form]: Close your eyes

    As well as routine laboratory tests, biomarkers can be measured help

    rule out other causes of dementia, for example, ApoE4 testing, but

    these tests are not routine. Genetic testing for ApoE4 or for familial

    (source: http://alzheimers.org.uk)

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    // Pocket Guide to Alzheimers Disease

    1.

    2.

    3.

    4.

    5.

    6.

    7.

    8.

    9.

    10.

    Memory loss that disrupts daily life

    Challenges in planning or solving problems

    Difficulty completing familiar tasks at home, at work or at leisure

    Confusion with time or place

    Trouble understanding visual images and spatial relationships

    New problems with words in speaking or writing

    Misplacing things and losing the ability to retrace steps

    Decreased or poor judgment

    Withdrawal from work or social activities

    Changes in mood and personality

    The Alzheimers Association (2009)10 warning signs of Alzheimers disease

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    // Pocket Guide to Alzheimers Disease

    New Diagnostic Criteriaand Guidelines for

    Alzheimer's DiseaseThe original clinical criteria for diagnosing Alzheimer's disease were

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    Now for the first time in nearly 30 years, the clinical diagnostic criteria

    for Alzheimer's disease dementia have been revised.Expert international workgroups convened by the Alzheimer's Association

    and the National Institute of Aging (NIA) have jointly issued four new

    criteria and guidelines to diagnose Alzheimer's disease. These new criteria

    update, refine and broaden previous widely used guidelines jointly issued

    by the Alzheimer's Association and the National Institute of Health(NIH) over the past 30 years (Jack et al, 2011).The final versions of

    the guidelines, revised to reflect input from the professional community

    at large, now appear as free-access papers in Alzheimer's and Dementia:

    The Journal of the Alzheimer's Association [abbreviated, Alzheimers

    Dement] (Albert et al, 2011; Jack et al, 2010; McKhann et al, 2011;

    Sperling et al, 2011). The new guidelines aim to improve current diagnosis,

    strengthen autopsy reporting of Alzheimer's brain changes, and establish

    a research agenda for future progress in earlier detection and even greater

    diagnostic accuracy

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    // Pocket Guide to Alzheimers Disease

    Alzheimer's disease progression

    EARLIEST ALZHEIMERS

    changes may begin years or

    more before diagnosis.

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    ABNORMAL

    NORMAL

    TIM

    Pre-Symptomatic eMCI lMCI Dementia

    CSFabeta 42

    CSF A42

    MRI Hippocampal Volume

    FDG-PET

    Amyloidimaging

    FxnCogCSF tau

    MRI hipp

    Alzheimers Disease Progression

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    // Pocket Guide to Alzheimers Disease

    Summary of New Diagnostic Criteria and

    Guidelines for Alzheimers DiseaseDementia due to Alzheimer's Disease

    Clinical symptom of dementia due to Alzheimer's disease are impairments

    in memory, thinking and behavior decrease a person's ability to functionindependently in everyday life (McKhann et al, 2011). The dementia due

    to Alzheimer's disease guideline updates and clarifies clinical criteria to

    diagnose dementia from all causes and specifically from Alzheimer's

    disease (McKhann et al, 2011). In the future, biomarker evidence may

    provide additional diagnostic certainty.

    The dementia due to Alzheimers as outlined in the new guidelines is

    further categorised into three sub-criteria:

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    Mild Cognitive Impairment (MCI) due to

    Alzheimer's Disease

    Symptoms of MCI due to Alzheimer's disease are noticible mild changes

    in memory and thinking that can be measured on mental status tests,

    but are not severe enough to disrupt a person's day-to-day life (Albert et

    al, 2011).The new guideline for MCI due to Alzheimer's disease is based on two

    sets of criteria:

    Core clinical criteria clinical and cognitive assessments that establish

    concern of change in cognition over time; impairment in 1 or more

    cognit