Alzheimer's disease "Dementia" – Chronic
Definition
Acquired multiple cognitive defects that include memory impairment in combination with aphasia, apraxia, agnosia or a disturbance of executive function that are severe enough to cause impairment in occupational or social functioning and that represent a decline from previous baseline functioning
Medical History
* Adult, Geriatric (>65 years)
* Genetic mutation
* Down syndrome [Down syndrome - Chronic]
* Depression [Depression - Chronic]
* Head trauma
* Dietary finding
* Hypertension [Hypertension - Chronic]
* Hypercholesterolemia
* Diabetes mellitus [Diabetes mellitus - Chronic]
* Hyperhomocysteinemia
* Generalized atherosclerosis
* Smoking
Findings
* Memory impairment
* Aphasia
* Apraxia
* Agnosia
* Executive dysfunction
* Depression - Chronic
* Delusions
* Hallucinations
* Agitation
* Personality change
* Aggressive behavior
* Undernourished
* Pressure sore - Chronic
* Muscle atrophy
Tests
Evaluation of suspected dementia
* Complete blood count
* Electrolytes measurement, serum
* Glucose measurement, serum
* Thyroid stimulating hormone measurement
* Measurement of renal function
* Hepatic function panel
Dementia related to vitamin B12 deficiency
* Serum vitamin B12 measurement: Low levels of vitamin B12 may be related to the development of Alzheimer disease or dementia .
Suspected dementia
* Radiography of head: CT or MRI of the head may be useful to identify abnormal pathology as a cause of dementia; however, functional neuroimaging using positron emission tomography (PET) and single photon computed emission tomography (SPECT) is not appropriate for routine examination .
Suspected dementia
* Dementia test: Dementia screening tests for use in primary care populations are reasonably accurate for detecting undiagnosed dementia in patients with cognitive impairment .
Differential Diagnosis
* Alzheimer's disease
* Vascular dementia
* Frontotemporal dementia
* Senile dementia of the Lewy body type
* Minimal cognitive impairment
* Depression - Chronic
* Parkinson's disease - Chronic
* HIV infection
* Huntington's disease - Chronic
* Alcohol abuse
* Traumatic brain injury
* Primary brain cancer - Acute
* Normal pressure hydrocephalus
* Vitamin deficiency
* Subacute sclerosing panencephalitis
* Jakob-Creutzfeldt disease - Chronic
* Wilson's disease - Chronic
* Neurosyphilis
* Hypothyroidism - Chronic
* Metabolic encephalopathy
* Delirium - Acute
* Schizophrenia - Chronic
* Amnestic disorder
* Factitious disorder - Acute
Treatment
Drug Therapy
Mild to moderate Alzheimer disease
DONEPEZIL HYDROCHLORIDE
Adults: Initial dose 5 mg orally daily; increase to 10 mg orally daily if tolerated
GALANTAMINE HYDROBROMIDE
Adults (immediate-release): Initial dose 4 mg orally twice daily; may increase to 8 mg orally twice daily after at least 4 weeks; may increase to 12 mg orally twice daily after at least 4 weeks if previous dose tolerated; maximum dose 32 mg orally per day
Adults (extended-release): Initial dose 8 mg orally once daily; may increase to 16 mg orally once daily after a minimum of 4 weeks; may increase to 24 mg orally daily after a minimum of 4 weeks
RIVASTIGMINE TARTRATE
Adults (oral dosing): Initial dose of 1.5 mg orally twice daily; may increase by 1.5 mg orally twice daily after a minimum of 2 weeks; maximum dose of 6 mg orally twice daily
Adults (transdermal dosing): Initial dose of 4.6 mg per 24 hours (5 cm2 patch) transdermally, change patch once daily; if well tolerated for a minimum of 4 weeks increase dose to 9.5 mg per 24 hours (10 cm2 patch) transdermally, change patch once daily (maximum dose 9.5 mg/24 hours)
Moderate to severe Alzheimer disease
DONEPEZIL HYDROCHLORIDE
Adults: Initial dose 5 mg orally daily; increase to 10 mg orally daily if tolerated
MEMANTINE HYDROCHLORIDE
Adults: Initial dose 5 mg orally daily; may increase by 5 mg/day every week until a maximum of 10 mg twice daily is reached
Psychosis and agitation in dementia
RISPERIDONE (Related toxicological information in RISPERIDONE)
Adults: Initial dose 0.25 to 1 mg orally daily (maximum, 1.5 to 2 mg/day)
OLANZAPINE (Related toxicological information in OLANZAPINE)
Adults: Initial dose 1.25 to 5 mg orally daily (maximum, 10 mg/day)
QUETIAPINE FUMARATE
Adults: Initial dose 12.5 to 50 mg orally daily (maximum, 200 to 300 mg/day)
HALOPERIDOL
Adults: Initial dose 0.25 to 0.5 mg orally daily (maximum, 2 mg/day)
Psychotic disorder
* Emotional and psychosocial support and education: The psychosocial and educational aspects of treatment can improve patient outcome and medication compliance and should focus on stress reduction .
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