Dr. Jose G.

Tamayo Medical University

Alzheimer’s Disease
Ansay, Klarence Faith
Bolante, Jeannine Melanie
Esmas, Aira Joy
Esperanza, Dexter Jan
Galigo, Lei Mikaela
Lopez, Virma Stephanie
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

PART I

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Introduction
• Alzheimer's disease is a neurodegenerative disorder that cannot be cured
and is classified as a progressive brain disorder since it gradually erodes a
person's memory and cognitive abilities.
• Dr. Alois Alzheimer found a change in the brain tissue of a woman who had
died of an uncommon mental disorder, and the disease was named after him.

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Alzheimer’s Disease vs. Dementia

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Epidemiology: Worldwide
• In the United States, Alzheimer's disease is the sixth largest cause of
death. (2015)
• According to a 2015 report, it affects 5.3 million people in the US.
• Alzheimer Disease and other dementias are more common in African
Americans, than in Caucasians.

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Epidemiology: Local
• According to the latest WHO data published in 2018, Alzheimer’s &
Dementia Deaths in the Philippines reached 1,047 or 0.17% of total
deaths.
• The age adjusted death rate is 1.98 per 100,000 of population,
therefore ranks Philippines #177 in the world.

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Pathophysiology

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Pathophysiology

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Pathophysiology

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Pathophysiology

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Pathophysiology

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Clinical Presentation: Clinical Signs

Stages Manifestations
Mild (Early) Patient has difficulty remembering recent events. Inability to manage finances,
prepare food, and carry out other household activities declines. May get lost while
(MMSE Score: driving. Begins to withdraw from difficult tasks and give up hobbies. May deny
26-18) memory problems.
Patients require assistance with activities of daily living. Frequently disoriented
Moderate (Middle) with regard to time (date, year, season). Recall for recent events is severely
impaired. May forget some details of past life and names of family and friends.
(MMSE Score: Functioning may fluctuate from day to day. Patient generally denies problems.
17-10) May become suspicious or tearful. Loses ability to drive safely. Agitation,
paranoia, and delusions are common.
Severe (Late) Patients lose the ability to speak, walk, and feed by themselves. Incontinent of
(MMSE Score: 9-0) urine and feces. Requires care 24 hours a day, 7 days a week.

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Clinical Presentation: Symptoms

• The patient may have vague memory complaints initially, or the patient’s
significant other may report that the patient is “forgetful.” Cognitive decline is
gradual over the course of illness. Behavioral disturbances may be present in
moderate stages. Loss of daily function is common in advanced stages.
• Cognitive
o Memory loss (Poor recall and losing items)
o Aphasia (Circumlocution and anomia)
o Apraxia Agnosia Disorientation (Impaired perception of time and unable to
recognize familiar people)
o Impaired executive function

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Clinical Presentation: Symptoms

• Noncognitive
o Depression, psychotic symptoms (Hallucinations and delusions)
o Behavioral disturbances (Physical and verbal aggression, motor
hyperactivity, uncooperativeness, wandering, repetitive
mannerisms and activities, and combativeness
• Functional
o Inability to care for self (Dressing, bathing, toileting, and eating)

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Diagnosis
• Patients with suspected AD should have a history and physical
examination with appropriate laboratory and other diagnostic tests,
neurologic and psychiatric examinations, standardized rating
assessments, functional evaluation, and a caregiver interview.
• Information about prescription drug use; alcohol or other substance
use; family medical history; and history of trauma, depression, or head
injury should be obtained.

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Diagnosis
• It is important to rule out medication use as a contributor or cause
of symptoms:
o Anticholinergics, sedatives, hypnotics, opioids, antipsychotics,
and anticonvulsants as contributors to dementia symptoms
• Other medications may contribute to delirium:
o Digoxin, nonsteroidal anti-inflammatory drugs, histamine2
receptor antagonists, amiodarone, anti-hypertensives, and
corticosteroids

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Diagnosis: Laboratory
•Rule out vitamin B12 and folate deficiency
•Rule out hypothyroidism with thyroid function tests
•Blood cell counts, serum electrolytes, liver function tests

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Diagnosis: Other Diagnostic Procedures

•CT scan
•MRI scan
•Folstein Mini-Mental State Examination (MMSE) can help
to establish a history of deficits in two or more areas of
cognition and establish a baseline against which to evaluate
change in severity. The average expected decline in an
untreated patient is 2 to 4 points per year

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Treatment: Non-pharmacologic

•Behavioral interventions

•Patient and carer education

•Low-fat/low-cholesterol diet

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Treatment: Pharmacologic & Pharmacotherapy

(Cognitive)

•Current pharmacotherapeutic interventions are primarily

symptomatic attempts to improve or maintain cognition.
•Successful treatment reflects a decline of less than 2 points
each year on the MMSE score.

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Cholinesterase Inhibitors
• No direct comparative trials have assessed the effectiveness of one agent over
another.
• If the decline in MMSE score is more than 2 to 4 points after treatment for 1
year with the initial agent, it is reasonable to change to a different cholinesterase
inhibitor. Otherwise, treatment should be continued with the initial medication
throughout the course of the illness.
• The most frequent adverse effects are mild to moderate GI symptoms (nausea,
vomiting, and diarrhea), urinary incontinence, dizziness, headache, syncope,
bradycardia, muscle weakness, salivation, and sweating. Abrupt discontinuation
can cause worsening of cognition and behavior in some patients

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Tacrine
•It was the first cholinesterase inhibitor approved for the
treatment of AD, but it has been replaced by safer drugs
which are better tolerated.

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Generic Name Donepezil Rivastigmine Galantamine
Brand Name Aricept Exelon Razadyne
Stage Mild to Moderate and Severe AD Mild to Moderate AD Mild to Moderate AD

A cholinesterase inhibitor slows the breakdown of acetylcholine by blocking the activity of acetylcholinesterase. By
Mechanism of Action
maintaining acetylcholine levels, the drug may help compensate for the loss of functioning brain cells.

It is a piperidine derivative with
specificity for inhibition of
Characteristics
acetylcholinesterase rather than
butyrylcholinesterase.
It has central activity at It is a cholinesterase inhibitor that also
acetylcholinesterase and has activity as a
butyrylcholinesterase sites, but low
activity at these sites in the periphery nicotinic receptor agonist.

Capsule Tablet
Tablet
Dosage Forms Oral solution Oral solution
Orally disintegrating tablet
Patch Extended-release (ER) capsule
Starting Dose
Starting Dose
1.5 mg twice a day
Starting Dose 4 mg twice a day
5 mg daily at bedtime 4.6 mg/day 8 mg daily for ER
Dosages Maintenance Dose Maintenance Dose
Maintenance Dose
5–10 mg daily 3–6 mg twice a day 8–12 mg twice a day
9.5 mg/day
16–24 mg daily for ER
(patch)
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N-methyl D-aspartate (NMDA) Antagonist

• Memantine
o It is not metabolized by the liver but is primarily excreted
unchanged in the urine (half-life of elimination = 60 to 80 hours).
o It is usually well tolerated, and side effects include constipation,
confusion, dizziness, hallucinations, headache, cough, and
hypertension

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Generic Name Memantine

Brand Name Namenda
Stage Moderate to Severe AD
It blocks glutamatergic neurotransmission by
Mechanism of Action antagonizing N-methyl-D-aspartate receptors,
which may prevent excitotoxic reactions.
It is used as monotherapy, and data suggest
that when it is combined with a cholinesterase
Characteristics
inhibitor, there is improvement in cognition
and activities of daily living.
Tablet
Dosage Forms
Orally disintegrating tablet
It is initiated at 5 mg/day and increased weekly
by 5 mg/day to the effective dose of 10 mg
Dosages
twice daily. Dosing must be adjusted in
patients with renal impairment.

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Treatment: Pharmacologic & Pharmacotherapy

(Non-cognitive)
• Pharmacotherapy is aimed at treating psychotic symptoms, inappropriate or
disruptive behavior, and depression.
• General guidelines are as follows:
o Use reduced dose
o Monitor closely
o Titrate dosage slowly
o Document carefully
o Periodically attempt to reduce medication in minimally symptomatic
patients.
• Psychotropic medications with anticholinergic effects should be avoided because
they may worsen cognition.
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Cholinesterase Inhibitors
•Donepezil
•Rivastigmine
•Galantamine
•Tacrine

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N-methyl D-aspartate (NMDA) Antagonist

•Memantine

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Antipsychotic Drugs
• Antipsychotic medications have traditionally been used to treat
disruptive behaviors and psychosis in AD patients.
• A meta-analysis showed that 17% to 18% of dementia patients
showed a modest treatment response to atypical antipsychotics.
Adverse events included somnolence, extrapyramidal symptoms,
abnormal gait, worsening cognition, cerebrovascular events, and
increased risk of death.

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Antipsychotic Drugs
• Typical antipsychotics may also be associated with a small increased
risk of death, as well as more severe extrapyramidal effects and
hypotension.
• First-generation antipsychotics are dopamine receptor antagonists
(DRA) and are known as typical antipsychotics.
• Second-generation antipsychotics are serotonin-dopamine
antagonists and are also known as atypical antipsychotics

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Generic Name Brand Name Dosage Characteristics Mechanism of Action

Haloperidol is a
phenylbutylpiperadine
Starting Dose The first-generation
derivative with
0.25 mg antipsychotics work
antipsychotic,
Haloperidol Haldol neuroleptic, and by inhibiting
Maintenance Dose
1-3 mg
antiemetic activities. dopaminergic
neurotransmission.
A Typical Antipsychotic Second-generation
Olanzapine is a synthetic antipsychotics work
Starting Dose derivative of by blocking D2
2.5 mg thienobenzodiazepine with dopamine receptors
Olanzapine Olanpresor antipsychotic, antinausea, as well as serotonin
Maintenance Dose and antiemetic activities.
receptor
5-10 mg
An Atypical Antipsychotic

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Generic Name Brand Name Dosage Characteristics Mechanism of Action

Quetiapine is an atypical
Starting Dose antipsychotic, which is
25 mg indicated for treatment of
Quetiapine Quetadin schizophrenia and bipolar
Maintenance Dose disorders
The first-generation
100-300 mg antipsychotics work
An Atypical Antipsychotic by inhibiting
Starting Dose Risperidone is a dopaminergic
0.25 mg benzisoxazole derivative neurotransmission.
Risperidone Aspidon with antipsychotic property. Second-generation
Maintenance Dose
antipsychotics work
0.75-2 mg An Atypical Antipsychotic
by blocking D2
Ziprasidone is an atypical dopamine receptors
Starting Dose antipsychotic used to treat as well as serotonin
2.5 mg schizophrenia, bipolar
Ziprasidone Geodone receptor
mania, and acute agitation
Maintenance Dose in schizophrenic patients
5-10 mg
An Atypical Antipsychotic

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Antidepressant Drugs
• Depression and dementia have many symptoms in common, and the
diagnosis of depression can be difficult, especially later in the course
of AD.

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Generic Name Brand Name Dosage Characteristics Mechanism of Action

Citalopram is a
bicyclicphthalene
Starting Dose derivative and
10 mg
selective serotonin
Citalopram Tazen
Maintenance Dose reuptake inhibitor
10-20 mg (SSRI), with
antidepressant and Inhibits the
anxiolytic activities reuptake of
Escitalopram, a serotonin leading
selective serotonin to an increase
Starting Dose reuptake inhibitor serotonin levels
5 mg
(SSRI) and the
Escitalopram Lexdin
Maintenance Dose S-enantiomer of
20-40 mg racemic citalopram, is
known to be the most
selective of SSRIs

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Generic Name Brand Name Dosage Characteristics Mechanism of Action

Fluoxetine is a
diphenhydramine
derivative and selective
serotonin reuptake
Starting Dose inhibitor with
5 mg antidepressant,
Fluoxetine Adep
Maintenance Dose anti-anxiety, Inhibits the
10-40 mg antiobsessional and
reuptake of
antibulimic activity and
serotonin leading
with potential
immunomodulating
to an increase
activity. serotonin levels
Starting Dose
Paroxetine is a selective
10 mg serotonin reuptake
Paroxetine Paxil inhibitor (SSRI) and, as
Maintenance Dose such, is identified as an
antidepressant.
10-40 mg
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Generic Name Brand Name Dosage Characteristics Mechanism of Action

Sertraline is a selective
Starting Dose serotonin reuptake
inhibitor (SSRI) used in Inhibits the reuptake of
25 mg
serotonin leading to an
Sertaline Deperin the therapy of depression,
increase serotonin
Maintenance Dose anxiety disorders and levels
75-100 mg obsessive-compulsive
disorder

Starting Dose Venlafaxine is a bicyclic Inhibits the reuptake of

phenylethylamine serotonin leading to an
25 mg
increase serotonin
compound. Venlafaxine is
Venlafaxine Effexor levels. At higher
a more potent inhibitor of
dosages, it also inhibits
Maintenance Dose serotonin reuptake than norepinephrine
75-225 mg norepinephrine reuptake. reuptake

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Generic Name Brand Name Dosage Characteristics Mechanism of Action

Trazodone is
triazolopyridine Trazodone is an
Starting Dose
derivative from the antidepressant that
25 mg
works by inhibiting
serotonin receptor
Trazodone Desyrel both serotonin
Maintenance antagonists and
transporter and
Dose reuptake inhibitors serotonin type 2
75-100 mg (SARIs) class of receptors.
antidepressants

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SSRI

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SNRI

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Miscellaneous Therapies
• Depression and dementia have many symptoms in common, and the
diagnosis of depression can be difficult, especially later in the course of
AD.
○ Carbamazepine, mean dose 300 mg/day, may improve psychosis
and behavioral disturbance in AD patients.
○ Oxazepam and other benzodiazepines have been used to treat
anxiety, agitation, and aggression, but they generally show inferior
efficacy compared with antipsychotics. They can also worsen
cognition, cause disinhibition, and increase the risk of falls.

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PART II

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General Patient Information

Demographics Patient Information
Name Norma Dale
Gender Female
Age 74 years old

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Chief Complaint
According to the daughter, the patient has become
uninterested and apathetic in the past month. The patient is not
always cooperative with daily function.

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History of Present Illness

∙ Date of Onset
o 6 years ago
∙ Nature of Onset, Severity, and Duration and Degree of Interference
with Daily Activities
o Forgetting times and dates easily, misplacing and losing items,
repeating questions and current events, inability to answer questions,
and increasing difficulty with managing finances.
∙ Effect of Any Treatment Given
o Tacrine
✔ Complexity of QID dosing and elevated liver enzymes
o Aricept 10 mg at bedtime
✔ Well-tolerated for the past 4 years
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History of Present Illness

∙ Relationship to Other Symptoms, Bodily Functions, or Activities
o Began using Depends undergarments as extra protection for urinary
incontinence.
o Displays lack of interest and apathy lately
o Lack of cooperation

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Past Medical History

∙ Serious Illness
o Alzheimer’s disease diagnosed 6 years ago
o Osteoarthritis in both knees × 6 years
∙ Surgical Procedures
o None
∙ Any Conditions Happened Before That Must Be Related to the Present
Illness
o None

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Family History

Age and health of patients, siblings,

5 children, Four live nearby
and children
For deceased relatives, the age, and Both parents deceased
caused of death (Noncontributory)

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Social History
Widowed for 10 years (Husband died of
Patient’s Marital Status
cancer)
Number of Children 5 children
Educational Background Not stated
Occupation Not stated
Physical Activity Not stated
Hobbies Not stated
Dietary Habits Not stated
Tacrine (discontinued due to complexity of
Use of tobacco, alcohol, and other drugs
QID dosing and elevated liver enzymes)

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Medications

Rx Medicines Aricept 10 mg PO at bedtime

Non-Rx Products Acetaminophen PRN
Vitamin E 400 IU PO once daily
Dietary Supplements
Ensure drinks PRN

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Allergy
• There is no allergy indicated.

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Review of Systems
ROS
Reports on occasional bladder incontinence
Knee pain
No complaints on heartburn
No complaints on chest pain and SOB

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Physical Examination
Physical Examination Result
General Appearance WD woman who appears her stated age
BP 126/76
P 76
RR 18
Vital Signs
T 37°C
Wt 120 lb
Ht 5'6''
Skin Normal texture and color
HEENT WNL, TMs intact
Nodes Neck supple without thyromegaly or
Neck/Lymph
lymphadenopathy
Lungs/Thorax Clear, normal breath sounds

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Physical Examination
Physical Examination Result
Breasts No masses or tenderness
CV RRR, no murmurs or bruits
Abd Soft, NTND
Genit/Rect Normal external female genitalia
MS/Ext No CCE, normal ROM
Motor, sensory, CNs, cerebellar, and gait normal. Folstein
MMSE score 16/30, compared to a score of 17/30 and
19/30, last year and at the initial diagnosis, respectively.
Disoriented to season, month, date, and day of week.
Neuro
Disoriented to the country. Good registration but impaired
attention and very poor short-term memory. Unable to
remember any of three items after 3 minutes. Able to
follow commands. Displayed apathy during MMSE.

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Laboratory
Lab Test Normal Values Result of Patient Interpretation
Na 135-145 mEq/L 139 mEq/L Normal
K 3.5-5.0 mEq/L 3.7 mEq/L Normal
Cl 98-106 mEq/L 108 mEq/L ↑
CO2 21-30 mEq/L 25.5 mEq/L Normal
BUN 10-20 mg/dL 16 mg/dL Normal
SCr <1.5 mg/dL 1.1 mg/dL Normal
Glu 75-115 mg/dL 102 mg/dL Normal
Hgb 12-16 g/Dl 13.5 g/dL Normal
Hct 36-46% 39.0% Normal

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Laboratory
Lab Test Normal Values Result of Patient Interpretation
AST 0-35 units/L 25 IU/L Normal
ALT 0-35 units/L 24 IU/L Normal
Alk phos 81 30-120 units/L 81 IU/L Normal
GGT 1-94 units/L 22 IU/L Normal
LDH 100-190 units/L 85 IU/L ↓
T. Bili 0.3-1.0 mg/dL 0.9 mg/dL Normal
D. Bili 0.1-0.3 mg/dL 0.3 mg/dL Normal
T. prot 5.5-8.0 g/dL 7.5 g/dL Normal
Alb 3.5-5.5 g/dL 4.5 g/dL Normal

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Laboratory
Lab Test Normal Values Result of Patient Interpretation
Chol <200 mg/dL 212 mg/dL ↑
Trig <160 mg/dL 155 mg/dL Normal
Ca 9.0 - 10.5 mg/dL 9.7 mg/dL Normal
Phos 2.6-4.5 mg/dL 4.5 mg/dL Normal
TSH 0.5-4.7 mIU/L 3.6 mIU/L Normal
T4 5.0-11.0 ug/dL 5.9 ng/dL Normal
UA 1.5-6.0 mg/dL 6.8 mg/dL ↑

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Diagnostic Test
Diagnostic Test Time Result
Mild to moderate generalized
CT Scan 4 years ago
cerebral atrophy

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Answer to Questions: Patient Focused

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Problem Identification:
Create a list of the patient’s drug therapy problems.

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For the patient’s initial drug therapy, she was prescribed Tacrine for the onset of
her disease, and taking this drug caused the patient to have elevated liver enzymes.
Due to this, as well as the Tacrine’s complexity of dosing which is 4x a day, it was
removed from her drug therapy. Hence, the normal AST and ALT from the
laboratory test.

On the other hand, we discovered a drug-drug interaction which is the Aricept

and Acetaminophen. A well-known side effect of Aricept is heartburn. In
connection to this, Acetaminophen, especially at high doses, may induce upper GI
symptoms such as abdominal pain/discomfort, heartburn, and nausea or vomiting.
Thus, taking these two concomitantly, poses a drug therapy problem.

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Problem Identification:
What information (signs, symptoms, laboratory
values) indicates the severity of the cognitive and
non-cognitive problems of this patient with
Alzheimer’s disease?

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Forgetting times and dates easily

Repeating questions and current events
Signs and Symptoms (Cognitive) Inability to answer questions
Misplacing and losing items
High difficulty with managing finances
Signs and Symptoms (Non-cognitive) Lack of interest and apathy
↑ Cl (Research studies suggest that high-salt diet
Laboratory Values is associated with cognitive decline, both in
humans and mouse)

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Desired Outcome:
What are the goals of pharmacotherapy in this case?

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UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

The goals of pharmacotherapy are to slow down the

progression of the disease and manage its symptoms to
maintain the quality of life of the patient as long as the
medication can do.

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Therapeutic Alternatives:
What non-drug therapies might be useful for this
patient?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

According to Alzheimer’s Association they recommend staying

physically (walking, cycling, gym work, and aerobics, yoga, dancing,
housework, gardening), mentally (reading books, listening to music,
working on puzzles or Sudoku), and socially active (bake or cook
simple recipes together, watching family videos, do arts and crafts
together, playing board games), adopting a low-fat/low-cholesterol diet
rich in dark vegetables and fruit, and managing body weight

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Therapeutic Alternatives:
What feasible pharmacotherapeutic alternatives are
available for the treatment of the cognitive deficits of
Alzheimer’s disease?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

The cognitive symptoms of the patients suggest that she has

moderate Alzheimer’s disease with a 16/30 MMSE score.
Rivastigmine, galantamine and memantine are drugs which can
be used as alternatives for her treatment based on the stage of her
Alzheimer’s disease as she is already taking donepezil.

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Therapeutic Alternatives:
What pharmacologic treatments may be useful to
treat the noncognitive symptoms and behaviors of
this patient?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

The noncognitive symptom of the patient is apathy which

was observed by her lack of interest. Treatments for apathy
depend upon the underlying cause. In the case of this patient,
the underlying cause is Alzheimer’s disease which is at
moderate stage hence cholinesterase inhibitors can be
prescribed such as donepezil (which is currently her treatment),
rivastigmine and galantamine. Moreover, memantine which is a
NMDA antagonist could also be prescribed.

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Therapeutic Alternatives:
What economic and psychosocial considerations are
applicable to this patient?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

In terms of economic considerations, it consists of follow up check up with the

psychologist, medication expenses, if the patient is considering some physical
therapies and having a focused diet low – fat/low –cholesterol diet and if the family
would be considering having a caregiver to take care of the patient.

In terms of psychosocial considerations it consists of progressive cognitive

symptoms (memory loss (poor recall and losing items), aphasia (circumlocution and
anomia), apraxia agnosia disorientation (impaired perception of time and unable to
recognize familiar people), impaired executive function), noncognitive (depression,
psychotic symptoms (hallucinations and delusions) ), behavioral disturbances
(physical and verbal aggression, motor hyperactivity, uncooperativeness, wandering,
repetitive mannerisms and activities, and combativeness) and functional where the
patient has inability to care for self (dressing, bathing, toileting, and eating)

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Optimal Plan:
What drug, dosage form, dose, schedule, and
duration of therapy are best for the cognitive and
noncognitive symptoms of this patient?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

For cognitive symptoms, the patient can be prescribed with cholinesterase

inhibitors such as donepezil, rivastigmine, galantamine and NMDA antagonist such
as memantine. In terms of her non-cognitive symptoms which is apathy, the patient
can be prescribed with the same medication with cognitive symptoms of Alzheimer’s
Disease since the underlying cause of her apathy is Alzheimer’s Disease which is at
moderate stage.
Drug Dosage Form Dose Schedule Duration
Once daily at
Donepezil Tablet 10 mg Long term
bedtime
Rivastigmine Capsule 1.5 mg Twice a day Long term
Extended-Release
Galantamine 8 mg Once daily Long term
Capsule
Memantine Tablet 10 mg Twice Daily Long term

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Optimal Plan:
What alternatives would be appropriate if the initial
therapy fails or cannot be used?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

One alternative therapy to be considered is aducanumab. This drug is

an Anti-Amyloid Antibody Drug which targets the beta-amyloid that
accumulates in the brain and forms plaques that disrupts communication
between nerve cells in the brain and is considered as one cause of
Alzheimer’s Disease. Preventing beta-amyloid build up may provide
benefits.

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Outcome Evaluation:
What clinical and laboratory parameters are necessary to
evaluate the therapy for achievement of the desired
therapeutic outcome and to detect or prevent adverse
effects?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Since up to date, there is still no drug for the treatment of Alzheimer’s Disease,
the goal of therapy is to reduce the incidence of symptoms, thereby improving the
quality of life of the patient and his/her caregiver.

In another note, the only clinical parameter directly linked to evaluating the
therapy for achievement of the desired therapeutic outcome, is the Mini–Mental
State Examination (MMSE) or Folstein test which is a widely used test of cognitive
function among the elderly; it includes tests of orientation, attention, memory,
language and visual-spatial skills. The original work of Folstein et al. (1975)
reported that the MMSE should be scored from 0 to 30, with a score of 24 or greater
as “normal” and with a score less than 20 “likely dementia.” In this particular case,
the patient has a score of 16/30 which indicates that the patient suffers from
dementia.

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Patient Education:
What information should be provided to the patient to
enhance compliance, ensure successful therapy, and
minimize adverse effects?

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

To enhance compliance, ensure successful therapy and minimize

adverse effects, we should provide some information and advice to the
carers of the patient. Evaluating adherence can help in enhancing
compliance, we can advise the carers to do the pill counting and daily
report of the activities of the patient. We can also advocate the carers on
the importance of taking the medicines at their appropriate time. Patient
and family communication can also help for the success of the therapy.
Active listening to the patient, providing clear messages, or even via
phone that shows concern and support to the patient would be a great
help. And lastly, monitoring the side effect of the medication or other
drug-to-drug interactions may minimize the adverse effects. It is also
better if the carers have contact with the pharmacist or the physician

COLLEGEOFPHARMACY
UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

References

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UNIVERSITY OF PERPETUAL HELP – DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

Alzheimers & Dementia in Philippines. (n.d.). World Life Expectancy. Retrieved

October 10, 2021, from
https://www.worldlifeexpectancy.com/philippines-alzheimers-dementia

Pharm.D, S. (n.d.). Pathophysiology and management of alzheimer’s disease.

Slideshare. Retrieved October 10, 2021, from
https://www.slideshare.net/SoujanyaThippabathin/pathophysiology-and-mana
gement-of-alzheimers-disease

Schwinghammer, T. L., & DiPiro, J. T. (2002). Pharmacotherapy casebook: A

patient-focused approach. New York: McGraw-Hill, Medical Pub.

Wells, B. G. (2009). Pharmacotherapy handbook. New York: McGraw-Hill,

Medical Pub. Division.

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