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Pharmacologic Treatment of Alzheimer's Disease: An Update

Source: www.aafp.org
Topic: Alzheimer
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Sort Desciption: Alzheimer's disease is characterized by the development of senile plaques and neurofibril ... Alzheimer's disease recommend periodic measurements of ...

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Pharmacologic Treatment of Alzheimers Disease: An Update genetic predisposition and environmental influences is probably responsible. 3 One of these influences may be subclinical ischemia, because patients with high blood pressure and elevated cholesterol levels tend to have an increased risk for Alzheimers disease. 4 Neurofibrillary tangles are made up partly of a protein called tau, which links together to form filaments. The density of these filaments within neurons in the brain is directly related to the severity of dementia. It is unclear why tangles form, but different alleles of a gene are known to create forms of tau that are more likely to tangle. 3 It is also unclear whether tangles are linked to plaque formation. The ultimate effect of the tangles, however, is compromise of microtubular function, with eventual destruction of the neuron. Involvement of cholinergic neurons causes levels of acetylcholine within synapses to decline. Levels of acetylcholinesterase also drop, perhaps to compensate for the loss of acetylcholine. Activity of another cholinesterase enzyme (butyrylcholinesterase) increases, and a significant portion of acetylcholine is metabolized by this enzyme as the disease progresses. Eventually, the neuron is destroyed. T he financial and social costs of Alzheimers disease are staggering. In the United States, the disease accounts for about $100 billion per year in medical and custodial expenses, with the average patient requiring an expenditure of about $27,000 per year for medical and nursing care. In addition, 80 percent of caregivers report stress, and about 50 percent report depression. 1,2 This article reviews the pathophysiology of Alzheimers disease, evidence for the efficacy of various pharmacologic treatments, and guidelines for the use of drug therapy in patients with this devastating disease. Pathophysiology Two microscopic changes occur in the brain in Alzheimers disease: senile plaques develop between neurons, and ...

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