Team 1

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

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

3. TreatmentsDrugs • Cholinesterase Inhibitors (mild to moderate) • 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) • Side Effects • Nausea/Vomiting • Loss of appetite • Increased frequency of bowel movements • Possible liver damage (Tacrine)

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

5. Drugs • Enbrel? • Used for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis • Has not been approved for Alzheimer’s • Therefore insurance does not pay. • http://www.youtube.com/watch?v=OhTtJkN3o2Y • http://www.youtube.com/watch?v=rAZhX7LEZeU

6. 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. • 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.

7. Stem Cells • 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). • The use of stem cells, raises ethical concerns.

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

9. 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.

10. Symptoms • 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.

11. 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.

12. 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. • Other medications include Bromocriptine, Pramipexole, Ropinirole which all mimic dopamine in the brain.

13. Treatment Options • 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.

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

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

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

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

18. Most Common Vascular Dementia • Multi-infarct dementia (helpguide.org). • Series of small strokes – sometimes called transient ischemic attacks (TIAs) • Often unnoticed • Damages the cortex of the brain • Temporary • Partial blockages of blood supply • 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 • When vascular dementia occurs with other types of dementia (e.g., Alzheimer's) it is referred to as “mixed dementia” (helpguide.org).

19. Treatment/Prevention of Vascular Dementia • No treatment can reverse damage caused by strokes (psychnet-uk.com, 2008) • Lower your risk for a stroke (helpguide.org). • 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). • Stroke • High blood pressure • Diabetes • High cholesterol and heart disease (psychnet-uk.com, 2008)

20. Prevention of Vascular Dementia Things you can do (helpguide.org): • Don’t smoke • Exercise regularly • Eat healthy (limit alcohol, salt and saturated fat) • Try to reduce stress (relaxation techniques) • Routine blood pressure checks • Medications for blood pressure and blood thinners (e.g., Aspirin). • 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).

21. Treatment of symptoms • Controlling symptoms of dementia (psychnet-uk.com, 2008). • 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). • Possible medications used (psychnet-uk.com, 2008): • Anti-Psychotics • Beta Blockers (if related to central nervous system lesions). • Serotonin-Affecting Drugs (e.g., lithium, trazodone, buspirone, clonazepam). • Dopamine Blockers • Carbamazepine • Fuoxetine, Imipramine • Stimulant drugs for mood (e.g., methylphenidate)

22. References • Hill, C. Treatment of alzheimers. Retrieved April 18, 2008 from http://alzheimers.about.com/od/treatmentofalzheimers/a/treatments.htm • 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 http://www.sciencenews.org/articles/20050430/fob1.asp • Helpguide.org (2007). Vascular dementia. Retrieved April 16, 2008 from http://www.helpguide.org/elder/vascular_dementia.htm • Huntington’s Disease Society of America. (2008). Talking technology. Retrieved April 18, 2008, from http://www.hdsa.org. • Mayo Clinic. (2008). Huntington’s disease. Retrieved April 18, 2008, from http://www.mayoclinic.com. • Mental health and psychology directory. (2008). Disorder information sheet. Retrieved April 16, 2008 from http://www.psychnet-uk.com/dsm_iv/dementia.htm • National Institute of Neurological Disorders and Stroke. (2008). NINDS huntington’s disease information page. Retrieved April 18, 2008, from http://www.ninds.nih.gov/disorders/huntington/huntington.htm. • National Institute of Neurological Disorders and Stroke. 2008 parkinson’s disease: hope through research. Retrieved April 19, 2008, from http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm • 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: http://www.umm.edu/nervous/parktrmt.htm

23. Wiki Page Link • http://wiki.ggc.usg.edu/mediawiki/index.php/PSYC3410:dementia/Team1