Criteria for Alzheimer’s Disease
- Memory loss plus 1 or more:
- Executive dysfunction
- Usually few motor signs apparent early
- Subtle behavioral and personality changes early
Screening Questions for Alzheimer’s Dementia
- Aphasia: can’t come up with words, substitutes words,
- Apraxia: has difficulty using utensils, tools
- Agnosia: doesn’t recognize familiar people; gets lost in
- Executive dysfunction: can’t manage checkbook, use computer
Features Inconsistent with Alzheimer’s Disease
- Sudden onset
- Focal neurological findings
- Seizures, early marked change in personality/behavior
- Gait disorder early in disease course
Summary of Cholinesterase Inhibitor Trials in AD:
- Nearly 9000 patients in 22 RCT, range 3 to 12 months of
donepezil (eg, Aricept), rivastigmine (eg, Exelon), or
galantamine (eg, Razadyne)
- Modest positive benefit in cognitive, behavioral, ADL, and
global scales; few side effects; modest side effects (GI) Rare
evidence of dose response
- Clinical outcomes (caregiver burden, nursing home placement,
etc) not measured
- Behavioral, ADL, and global scales modestly better in
- Clinical outcomes (eg, caregiver burden) not measured.
- ADR: Falls
- Conclusion: Use in moderate dementia if intolerant of
CIs or severe dementia.
- Caprylidene (Axona) is a medium-chain triglyceride derived
from coconut or palm oil.
- Theory: Alternative fuel for brain of AD patients
(poor uptake of glucose).
- Small, short-term, manufacturer-sponsored trials show
- Approximately $90 per month.
Lifestyle and Dementia
- Bronx Aging Study: Education and cognitive leisure
activities “protective” against development of AD (N Engl J Med.
- 15 minutes aerobic exercise 3x/week reduces
likelihood of dementia (Ann Intern Med. 2006;144(2):73-80)