Alzheimer’s Diagnosis and Management
By: Rachel Nall, RN, BSN, CCRN
Editors Note: This CME session has expired. You can no longer earn CME from this session, however, NeuroSeriesLive.com has many other CME programs, including in Alzheimer’s. To get the latest information, go to NeuroSeriesLive.com
After more than three decades of using the same diagnostic criteria for Alzheimer’s disease, recent research yielded a new set of standards for diagnosis. This new criteria impacts treatment strategies and offers hope for improving patient outcomes, according to medical experts in “Alzheimer’s Disease in 2015: Diagnosis and Management Across the Disease Spectrum,” a CME video presentation for the virtual education summit, NeuroSeriesLive.
James E. Galvin, MD, MPH, Professor and Associate Dean at the Charles E. Schmidt College of Medicine at Florida Atlantic University, outlines strategies from the National Institute on Aging. Establishing the presence of dementia is a key criterion. He goes on to explain doctors determine if dementia is present by observing changes in a person’s behavior that cannot be explained by other disease.
Upon a dementia determination, Dr. Galvin recommends a thorough assessment by a patient and his or her family members to identify changes they observed in at least two of five “domains.”
“Now it doesn’t have to be memory, but memory is one of the domains we look at,” Dr. Galvin explains. “But it could be language, visual/spacial abilities, executive functions, so reason and problem solving, or changes in personality and behavior.”
To see Dr. Galvin’s criteria in greater detail, click here.
Use of Biomarkers in Alzheimer‘s Diagnosis
One of the emerging diagnostic criteria for Alzheimer’s disease includes the use of biomarkers. Dr. Galvin discusses the different types and multiple sources of biomarkers as well as their use in a predictive, diagnostic, or monitoring capacity.
Dr. Galvin illustrates the uses of biomarkers such as amyloid, tau, and homocysteine for clinical practice by examining several available peer-reviewed studies.
“Right now, there’s really no clear evidence that CSF or serum biomarkers have true established clinical validity,” says Dr. Galvin. “But I think the criteria is changing, we are beginning to understand more and more how valuable biomarkers may be, they can help with a differential diagnosis.”
Combining biomarkers, magnetic resonance imaging (MRI) scans, and a thorough clinical assessment may help clinicians diagnose Alzheimer’s disease at an earlier stage, according to Dr. Galvin. With early detection, doctors can better plan for treatment and care, possibly delaying the worst effects of the disease with early intervention.
Applications for Alzheimer’s Treatment
Martin R. Farlow, MD, Professor of Neurology at Indiana University School of Medicine continues the Alzheimer’s-focused presentation by discussing the symptoms and treatment of dementia. He provides guidelines for beginning treatment such as stopping unnecessary medications and addressing any behavioral issues.
Alzheimer’s frequently has co-morbidities such as hypertension, arthritis, diabetes, coronary artery disease (CAD) and stroke. Farlow stressed the effective management of any co-morbidities to improve activities of daily living, and urged doctors to watch multiple medications for possible interactions or side effects to the patient.
This transitions to a discussion of some of the treatments available for cognitive deficits. Dr. Farlow discusses starting dosages and dosage ranges for drugs such as donepezil (Aricept), rivastigmine (Exelon), galantamine (Nivalin, Razadyne or Reminyl) and memantine (Namenda) extended and immediate-release.
For the latest in drug treatment options: View the video
“It is important that patients not be started at their maximal dose or therapeutic dose, you need to titrate up from a beginning dose…the body needs to develop tolerance to these medications,” says Dr. Farlow.
During the titration period, Farlow noted a range of side effects from nausea to diarrhea to leg cramping and-more serious but extremely rare-cardiac arrhythmias.
Advancements in treatments allow patients to take drugs with more convenient dosages and minimal side effects. Dr. Farlow gave examples such as galantamine XL, which is now available via a once per day tablet instead of BID dosing. He also mentions the rivastigmine patch, which provides a significant reduction in GI adverse affects.
Minimizing Symptoms Post-Diagnosis
Dr. Farlow noted medication compliance is a crucial component of Alzheimer’s treatment. He recommends early follow-up appointments with nurses and handouts with instructions for care to promote compliance. Additionally, he emphasizes the importance of detecting and treating other illnesses that could further contribute to Alzheimer’s symptoms. These include depression, pain, dehydration, and insomnia.
Farlow cited recent research proving some medications commonly taken by elderly Alzheimer’s patients, such as benadryl, elavil, and oxybutynin, can further negatively affect cognitive function.
Ultimately, Alzheimer’s is a progressive disease, but clinicians do have an opportunity to enhance a patient’s quality of life. “You have to look at the individual patients” Dr. Farlow says. “We need to go forward and choose the most appropriate drugs in our clinical experience and with the evidence base available to help with these symptoms and manage these patients.”
To learn more about the topics discussed and to watch Drs. Farlow and Galvin apply these discussions to a case study, view “Alzheimer’s Disease in 2015: Diagnosis and Management Across the Disease Spectrum” for continuing medical education (CME) credits on NeuroSeries Live.
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