Which of the following scores on an MMSE would indicate mild Alzheimer's?
The severity of Alzheimer's is defined as follows:-
Mild = MMSE 21-26
Moderate = MMSE 10-20
Severe = MMSE 0-10
Exam Question Dec 2012Mild = MMSE 21-26
Moderate = MMSE 10-20
Severe = MMSE 0-10
Alzheimer's (treatment)
Acetylcholinesterase inhibitors (AChE inhibitors) prevent cholinesterase from breaking down acetylcholine. Acetylcholine is deficient in Alzheimer's and therefore they are useful in this condition.
Acetylcholinesterase inhibitors used in the management of Alzheimer's include:-
- Donepezil (specific and reversible inhibitor of AChE)
- Galantamine (selective, competitive and reversible inhibitor of AChE, also enhances the effect of acetylcholine on nicotinic receptors)
- Rivastigmine (an AChE and butyrylcholinesterase inhibitor)
Gastrointestinal side effects from these drugs (nausea and vomiting) are common.
In addition to acetylcholinesterase inhibitors a drug called memantine is also used. This is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction.
NICE make the following recommendations about the treatment of Alzheimer's disease:-
- The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine are recommended as options for managing mild to moderate Alzheimer's disease
- Memantine is recommended as an option for managing Alzheimer's disease for people with moderate Alzheimer's disease who are intolerant of or have a contraindication to AChE inhibitors or for severe Alzheimer's disease
Where severity is defined as follows:-
- Mild = MMSE 21-26
- Moderate = MMSE 10-20
- Severe = MMSE 0-10
NICE technology appraisal guidance 217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of NICE technology appraisal guidance 111). March 2011.
Side effects of the antidementia drugs include cholinergic effects such as nausea, diarrhea, and dizziness.
