Team 1 Treatments for Alzheimer’s Parkinson’s, Huntington’s and Vascular types of dementia By: Andrew, Anne, Connie and Diana

Alzheimer’s Disease A type of dementia characterized by progressive neurological degeneration and deterioration of mental functioning. A type of dementia characterized by progressive neurological degeneration and deterioration of mental functioning. This disease results in impairment of : This disease results in impairment of : Language Language Memory Memory Visual-Spatial Orientation Visual-Spatial Orientation THERE IS NO CURE

Treatments Drugs Cholinesterase Inhibitors (mild to moderate) Cholinesterase Inhibitors (mild to moderate) Increase CNS acetylcholine (Ach) by inhibiting cholinesterase activity in the synapse. Increase CNS acetylcholine (Ach) by inhibiting cholinesterase activity in the synapse. Tacrine (Cognex) Donepezil (Aricept)] Galantamine (Razadyn (name changed from Reminyl June 2005)) Rivastigmine (Exelon) Tacrine (Cognex) Donepezil (Aricept)] Galantamine (Razadyn (name changed from Reminyl June 2005)) Rivastigmine (Exelon)(Cognex)(Aricept)Razadyn (name changed from Reminyl June 2005)Exelon(Cognex)(Aricept)Razadyn (name changed from Reminyl June 2005)Exelon Side Effects Side Effects Nausea/Vomiting Nausea/Vomiting Loss of appetite Loss of appetite Increased frequency of bowel movements Increased frequency of bowel movements Possible liver damage (Tacrine) Possible liver damage (Tacrine)

Treatments Drugs Memantine (moderate to severe) Memantine (moderate to severe) Works by regulating glutamate which plays a key role in processing, storage and retrieval of information. Works by regulating glutamate which plays a key role in processing, storage and retrieval of information. Namenda Namenda Side Effects Side Effects Headache Headache Constipation Constipation Confusion Confusion Dizziness Dizziness

Drugs Enbrel? Enbrel? Used for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis Used for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis Has not been approved for Alzheimer’s Has not been approved for Alzheimer’s Therefore insurance does not pay. Therefore insurance does not pay. o2Y o2Y o2Y o2Y EZeU EZeU EZeU EZeU

Gene Therapy Combined with Nerve Growth Factor (NGF) Put extra copies of the gene in the brain of people with Alzheimer’s for cellular growth factor and it slows the degenerative condition. Put extra copies of the gene in the brain of people with Alzheimer’s for cellular growth factor and it slows the degenerative condition. A study in 1996 involving monkeys (Tuszynski & Blesch) who received grafts that produced NCF retained twice as many cholinergic neurons than those receiving control grafts. A study in 1996 involving monkeys (Tuszynski & Blesch) who received grafts that produced NCF retained twice as many cholinergic neurons than those receiving control grafts. A clinical trial on eight patients with mild AD (Tuszynski and others, 2005) showed no adverse effects after 22 months and showed increased metabolic activity and an autopsy performed on another patient showed robust neuronal growth. A clinical trial on eight patients with mild AD (Tuszynski and others, 2005) showed no adverse effects after 22 months and showed increased metabolic activity and an autopsy performed on another patient showed robust neuronal growth.

Stem Cells The use of embryonic stem cells have been touted as possibilities in treating a variety of neurological diseases The use of embryonic stem cells have been touted as possibilities in treating a variety of neurological diseases Researchers have injected human neuronal stem cells into the lateral ventricles of 2-month and 24 month old rats, in the older rats it showed dramatic cognitive improvement (Qu & others, 2001; Sugaya, 2005). Researchers have injected human neuronal stem cells into the lateral ventricles of 2-month and 24 month old rats, in the older rats it showed dramatic cognitive improvement (Qu & others, 2001; Sugaya, 2005). The use of stem cells, raises ethical concerns. The use of stem cells, raises ethical concerns.

Interventions and Reality Orientation Programs The use of mnemonic techniques The use of mnemonic techniques Memory aids that help improve retrieval and storage information. Memory aids that help improve retrieval and storage information. Rely on associative processes to link events. Rely on associative processes to link events. Reality orientation programs Reality orientation programs Allows AD patients to maintain awareness of who they are. Allows AD patients to maintain awareness of who they are. Support groups for families and caregivers. Support groups for families and caregivers.

Parkinson’s Disease  According to the University of Maryland Medicine (UMM) Parkinson’s disease (PD) belongs to a group of conditions called motor system disorders which are the result of the loss of dopamine producing brain cells.  It is a slowly progressing degenerative disease that is usually associated with the following symptoms: tremor or trembling of the arms, jaw, legs and face, stiffness or rigidity of limbs and trunk, brady-kinesia (slowness of movement), postural instability, impaired balance and coordination.

Symptoms As the symptoms become more pronounced, patients may have difficulty walking and talking, sleeping, chewing, swallowing, completing daily tasks. As the symptoms become more pronounced, patients may have difficulty walking and talking, sleeping, chewing, swallowing, completing daily tasks. About 50,000 Americans are diagnosed with Parkinson’s each year. It is believed that more people suffer from Parkinson’s than multiple sclerosis, muscular dystrophy and, amyotrophic lateral sclerosis combined. About 50,000 Americans are diagnosed with Parkinson’s each year. It is believed that more people suffer from Parkinson’s than multiple sclerosis, muscular dystrophy and, amyotrophic lateral sclerosis combined.

Prevalence and Treatments  The prevalence of Parkinson's increases with age - appearing in 1% of people over 60 and 4-5% of those over 85 but, the average onset is usually in the late fifties.  Young onset PD refers to symptoms that begin as early as in the twenties and thirties.  There is no cure for Parkinson’s but, treatment is given based on the severity of symptoms. The University of Maryland Medicine says that anti-parkinsonian medication can be prescribed depending on the degrees of functional impairment, cognitive impairment, ability to tolerate the medications as well as advice from physicians.

Drugs According to the National Institute of Neurological Disorders and Stroke, Levadopa (L-Dopa), a natural chemical found in plants and animals, has been used for over thirty years to treat Parkinson’s Disease. Nerve cells use the levadopa to make dopamine and replenish the brain’s dwindling supply. This medication helps about ¾ of patients. L-Dopa is used to help reduce brady-kinesia, rigidity and tremors. According to the National Institute of Neurological Disorders and Stroke, Levadopa (L-Dopa), a natural chemical found in plants and animals, has been used for over thirty years to treat Parkinson’s Disease. Nerve cells use the levadopa to make dopamine and replenish the brain’s dwindling supply. This medication helps about ¾ of patients. L-Dopa is used to help reduce brady-kinesia, rigidity and tremors. Other medications include Bromocriptine, Pramipexole, Ropinirole which all mimic dopamine in the brain. Other medications include Bromocriptine, Pramipexole, Ropinirole which all mimic dopamine in the brain.

Treatment Options Surgery becomes an option when the disease does not respond to drugs any longer or at all. Surgery becomes an option when the disease does not respond to drugs any longer or at all. In a therapy called Deep Brain Stimulation (DBS) electrodes are implanted into the brain and connected to a device called a neurostimulator which can be externally programmed. This neurostimulator is used to deliver electrical stimulation to areas in the brain that control movement. This blocks the abnormal nerve signals that cause the tremors and other symptoms of Parkinson’s Disease. In a therapy called Deep Brain Stimulation (DBS) electrodes are implanted into the brain and connected to a device called a neurostimulator which can be externally programmed. This neurostimulator is used to deliver electrical stimulation to areas in the brain that control movement. This blocks the abnormal nerve signals that cause the tremors and other symptoms of Parkinson’s Disease.

Huntington’s Disease No Cure No Cure Medications Medications Tranquilizers like Klonopin Tranquilizers like Klonopin Antipsychotics like Haldol or Clozaril Antipsychotics like Haldol or Clozaril Antidepressants like Zoloft Antidepressants like Zoloft Lithium drugs like Lithobid Lithium drugs like Lithobid

Huntington’s Disease Physical Therapy/ Occupational Therapy Physical Therapy/ Occupational Therapy Speech Therapy Speech Therapy Picture boards Picture boards Experimental Treatments Experimental Treatments Cancer Drugs and AIDS drugs Cancer Drugs and AIDS drugs Coenzyme Q10 Coenzyme Q10

Self - Care for Huntington’s Proper Hydration Proper Hydration Exercise Regularly Exercise Regularly Continue proper nutrition Continue proper nutrition 5,000 calories per day 5,000 calories per day Vitamins and supplements Vitamins and supplements

What is Vascular Dementia? Second most common form of dementia in the U.S. (helpguide.org). Second most common form of dementia in the U.S. (helpguide.org). Caused by blockages in the brain’s blood supply (helpguide.org). Caused by blockages in the brain’s blood supply (helpguide.org). Vascular dementia is a degenerative cerebrovascular disease (helpguide.org). Vascular dementia is a degenerative cerebrovascular disease (helpguide.org). Leads to a progressive decline in (helpguide.org): Leads to a progressive decline in (helpguide.org): Memory Memory Cognitive functioning Cognitive functioning Usually occurs between the ages of 60 and 70 (helpguide.org). Usually occurs between the ages of 60 and 70 (helpguide.org). Affects more men than women (helpguide.org). Affects more men than women (helpguide.org).

Most Common Vascular Dementia Multi-infarct dementia (helpguide.org). Multi-infarct dementia (helpguide.org). Series of small strokes – sometimes called transient ischemic attacks (TIAs) Series of small strokes – sometimes called transient ischemic attacks (TIAs) Often unnoticed Often unnoticed Damages the cortex of the brain Damages the cortex of the brain Temporary Temporary Partial blockages of blood supply Partial blockages of blood supply Brief impairments in consciousness or sight Brief impairments in consciousness or sight Over time – the damage caused to brain tissue interferes with basic cognitive functions and disrupts day to day functioning Over time – the damage caused to brain tissue interferes with basic cognitive functions and disrupts day to day functioning When vascular dementia occurs with other types of dementia (e.g., Alzheimer's) it is referred to as “mixed dementia” (helpguide.org). When vascular dementia occurs with other types of dementia (e.g., Alzheimer's) it is referred to as “mixed dementia” (helpguide.org).

Treatment/Prevention of Vascular Dementia No treatment can reverse damage caused by strokes (psychnet-uk.com, 2008) No treatment can reverse damage caused by strokes (psychnet-uk.com, 2008) Lower your risk for a stroke (helpguide.org). Lower your risk for a stroke (helpguide.org). Risk for vascular dementia is nine times higher following a stroke Risk for vascular dementia is nine times higher following a stroke Risk factors of vascular dementia are the same as for (psychnet-uk.com, 2008). Risk factors of vascular dementia are the same as for (psychnet-uk.com, 2008). Stroke Stroke High blood pressure High blood pressure Diabetes Diabetes High cholesterol and heart disease (psychnet-uk.com, 2008) High cholesterol and heart disease (psychnet-uk.com, 2008)

Prevention of Vascular Dementia Things you can do (helpguide.org): Don’t smoke Don’t smoke Exercise regularly Exercise regularly Eat healthy (limit alcohol, salt and saturated fat) Eat healthy (limit alcohol, salt and saturated fat) Try to reduce stress (relaxation techniques) Try to reduce stress (relaxation techniques) Routine blood pressure checks Routine blood pressure checks Medications for blood pressure and blood thinners (e.g., Aspirin). Medications for blood pressure and blood thinners (e.g., Aspirin). Even surgery may be necessary to restore blood flow to the brain. Even surgery may be necessary to restore blood flow to the brain. Carotid endarterectomy – removes blockage in the carotid artery (the main blood vessel to the brain) (psychnet-uk.com). Carotid endarterectomy – removes blockage in the carotid artery (the main blood vessel to the brain) (psychnet-uk.com).

Treatment of symptoms Controlling symptoms of dementia (psychnet-uk.com, 2008). Controlling symptoms of dementia (psychnet-uk.com, 2008). Treatment varies with the specific disorder Treatment varies with the specific disorder Medications may be need to help with aggressive or agitated behaviors (including behaviors dangerous to themselves or others) (psychnet-uk.com, 2008). Medications may be need to help with aggressive or agitated behaviors (including behaviors dangerous to themselves or others) (psychnet-uk.com, 2008). Possible medications used (psychnet-uk.com, 2008): Possible medications used (psychnet-uk.com, 2008): Anti-Psychotics Anti-Psychotics Beta Blockers (if related to central nervous system lesions). Beta Blockers (if related to central nervous system lesions). Serotonin-Affecting Drugs (e.g., lithium, trazodone, buspirone, clonazepam). Serotonin-Affecting Drugs (e.g., lithium, trazodone, buspirone, clonazepam). Dopamine Blockers Dopamine Blockers Carbamazepine Carbamazepine Fuoxetine, Imipramine Fuoxetine, Imipramine Stimulant drugs for mood (e.g., methylphenidate) Stimulant drugs for mood (e.g., methylphenidate)

References Hill, C. Treatment of alzheimers. Retrieved April 18, 2008 from Hill, C. Treatment of alzheimers. Retrieved April 18, 2008 from Klein, S. B. & Thorne, B. M. (2006). Biological psychology. Worth: Washington D.C. Klein, S. B. & Thorne, B. M. (2006). Biological psychology. Worth: Washington D.C. Seppa, N. (2005). Neuron savers: Gene therapy slows alzheimer’s disease. Retreived April 18, from Seppa, N. (2005). Neuron savers: Gene therapy slows alzheimer’s disease. Retreived April 18, from Helpguide.org (2007). Vascular dementia. Retrieved April 16, 2008 from Helpguide.org (2007). Vascular dementia. Retrieved April 16, 2008 from Huntington’s Disease Society of America. (2008). Talking technology. Retrieved April 18, 2008, from Huntington’s Disease Society of America. (2008). Talking technology. Retrieved April 18, 2008, from Mayo Clinic. (2008). Huntington’s disease. Retrieved April 18, 2008, from Mayo Clinic. (2008). Huntington’s disease. Retrieved April 18, 2008, from Mental health and psychology directory. (2008). Disorder information sheet. Retrieved April 16, 2008 from Mental health and psychology directory. (2008). Disorder information sheet. Retrieved April 16, 2008 from National Institute of Neurological Disorders and Stroke. (2008). NINDS huntington’s disease information page. Retrieved April 18, 2008, from National Institute of Neurological Disorders and Stroke. (2008). NINDS huntington’s disease information page. Retrieved April 18, 2008, from National Institute of Neurological Disorders and Stroke parkinson’s disease: hope through research. Retrieved April 19, 2008, from National Institute of Neurological Disorders and Stroke parkinson’s disease: hope through research. Retrieved April 19, 2008, from University of Maryland Medicine. (2003, May). Nervous system diseases: Treatments for parkinson’s diseases. Retrieved April 19, 2008 from the University of Maryland Medical System Web site: University of Maryland Medicine. (2003, May). Nervous system diseases: Treatments for parkinson’s diseases. Retrieved April 19, 2008 from the University of Maryland Medical System Web site:

Wiki Page Link PSYC3410:dementia/Team1 PSYC3410:dementia/Team1 PSYC3410:dementia/Team1 PSYC3410:dementia/Team1