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Sections Alzheimer Disease
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References
Guidelines Summary
Alzheimer's Association
In 2018, the Alzheimer's Association released the first clinical practice guidelines for the evaluation of cognitive impairment suspected to be a result of Alzheimer's disease and related dementias in both primary care and specialty care settings. The guidelines contain 20 recommendations, 16 of which are classified as "A" recommendations. The primary recommendation is that all middle-aged or older individuals who self-report or for whom their care partner reports cognitive, behavioral, or functional changes undergo a timely multitiered evaluation. Other recommendations emphasize the importance of obtaining a history from the patient and someone who knows the patient well to establish the presence and characteristics of any substantial changes to categorize the cognitive behavioral syndrome, investigate possible causes and contributing factors to arrive at a diagnosis/diagnoses, and appropriately educate, communicate findings and diagnosis, and ensure ongoing management, care, and support. [153]
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APP is associated with the cell membrane, the thin barrier that encloses the cell. After it is made, APP sticks through the neuron's membrane, partly inside and partly outside the cell. Image courtesy of NIH.
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Enzymes (substances that cause or speed up a chemical reaction) act on the APP and cut it into fragments of protein, one of which is called beta-amyloid. Image courtesy of NIH.
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The beta-amyloid fragments begin coming together into clumps outside the cell, then join other molecules and non-nerve cells to form insoluble plaques. Image courtesy of NIH.
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Healthy neurons. Image courtesy of NIH.
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Image courtesy of NIH.
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Preclinical Alzheimer disease. Image courtesy of NIH.
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Mild Alzheimer disease. The disease begins to affect the cerebral cortex, memory loss continues, and changes in other cognitive abilities emerge. The clinical diagnosis of AD is usually made during this stage. Image courtesy of NIH.
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Severe Alzheimer disease. In the last stage of AD, plaques and tangles are widespread throughout the brain, and areas of the brain have atrophied further. Patients cannot recognize family and loved ones or communicate in any way. They are completely dependent on others for care. All sense of self seems to vanish. Image courtesy of NIH.
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Preclinical Alzheimer disease. Image courtesy of NIH.
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Mild-to-moderate Alzheimer disease. Image courtesy of NIH.
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Severe Alzheimer disease. Image courtesy of NIH.
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Cortical atrophy with hydrocephalus ex vacuo is seen in Alzheimer disease.
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Plaques and tangles in Alzheimer disease.
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Amyloid angiopathy in Alzheimer disease.
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Coronal T1-weighted magnetic resonance imaging (MRI) scan in a patient with moderate Alzheimer disease. Brain image reveals hippocampal atrophy, especially on the right side.
Tables
Shaheen E Lakhan, MD, PhD, MS, MEd, FAAN Clinical Professor of Neurology, Western University of Health Sciences
Shaheen E Lakhan, MD, PhD, MS, MEd, FAAN is a member of the following medical societies: American Academy of Neurology, American Medical Association, International Association for the Study of Pain
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cleveland Clinic; UCLA; MGH; California University of Science and Medicine; Carilion Clinic; Sage Therapeutics; The Learning Corp; Zogenix; Fern Health; Thriveworks; Click Therapeutics; Neurocrine; NeuroSport; SpineThera; Shaheen E. Lakhan, MD.
Jasvinder Chawla, MD, MBA Chief of Neurology, Hines Veterans Affairs Hospital; Professor of Neurology, Loyola University Medical Center
Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American Medical Association
Disclosure: Nothing to disclose.
Heather S Anderson, MD Associate Professor, Staff Neurologist, Department of Neurology, University of Kansas Alzheimer's Disease Center
Heather S Anderson, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.
Guy E Brannon, MD Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company
Guy E Brannon, MD is a member of the following medical societies: American Medical Association, American Medical Writers Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Clinical Research Professionals, Louisiana State Medical Society, and Southern Medical Association
Disclosure: AstraZeneca Grant/research funds Other; Janssen Grant/research funds Other; Pfizer Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Eli Lilly Grant/research funds Other; Forrest Grant/research funds Other
Linda P Boswell, MD Medical Director of Senior Care Unit, Bossier Medical Center; Private Practice, Shreveport, Louisiana
Linda P Boswell, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Louisiana State Medical Society
Disclosure: Nothing to disclose.
Jody L Haddock, MD Resident Physician, Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga
Disclosure: Nothing to disclose.
Rodrigo O Kuljis, MD Esther Lichtenstein Professor of Psychiatry and Neurology, Director, Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Miami School of Medicine
Rodrigo O Kuljis, MD is a member of the following medical societies: American Academy of Neurology and Society for Neuroscience
Disclosure: Nothing to disclose.
Alan D Schmetzer, MD Professor, Vice-Chair for Education, Assistant Training Director in General Psychiatry and Director of Residency Training in Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine
Alan D Schmetzer, MD, is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy
Disclosure: Eli Lilly & Co. Grant/research funds Other
Ronald Schneider, MD Chief Medical Officer, Mental Health Outreach Program, Overton Brooks Veterans Affairs Medical Center; Clinical Assistant Professor of Psychiatry, Louisiana State University Health Sciences Center
Ronald Schneider, MD is a member of the following medical societies: American Psychiatric Association and Louisiana Psychiatric Medical Association
Disclosure: Pfizer Honoraria Speaking and teaching; Janssen Honoraria Speaking and teaching
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
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