1. Alzheimer's: An Investigation into Treatment Options Dana McGuire and Jessica Scharfenberg MPH 543: Leadership and Organizational Management Concordia University June 2015

2. What is Alzheimer’s Disease? It is the most common cause of dementia and a primary progressive degenerative disease of nerve cells in the brain.

4. Risk Factors Age Family History Genetics Sex Past history of head trauma Heart Health

5. Disease Progression Mild (Early Stage) Moderate (Middle Stage) Severe (Late Stage)

6. Mild (Early Stage) Alzheimer’s Function Independently but feel they have memory lapses Word searching-Unable to come up with the right word or name Difficulty performing tasks in social settings Losing or misplacing objects Trouble with planning and organizing

7. Moderate (Middle Stage) Alzheimer’s Forgetfulness of one’s personal history Withdrawal from social situations Troubles with bladder and bowel control Wandering Changes in sleep pattern Delusions and compulsiveness

8. Severe (Late Stage) Alzheimer’s 24 hour care is needed Loss of awareness to surroundings Assistance of all daily activities including eating, grooming, and bathing Difficulties communicating Increasing vulnerability to infections

9. Direct Costs $172 billion each year (indirect and direct) Hospitalizations Nursing Homes/Groups Homes for 24 hour care Accidents Medical Bills Research

10. Indirect Costs Mental anguish of family members Depression Setting up a safe environment Absenteeism Lost productivity

12. Current Treatment Options Cholinesterase Inhibitors- inhibit the breakdown of Acetylcholine and prevents the destruction of nerve cells. Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne)

13. Donepezil (Aricept) Benefits Highly Specific Reversible Inhibitor Use for all stages of disease Taken once daily Side Effects Nausea Vomiting Diarrhea

14. Rivastigmine (Exelon) Benefits Mild to Moderate Stages Pill, syrup, or skin patch As good as Aricept Can block activity of other enzymes Side Effects Nausea Vomiting Diarrhea Weightloss

15. Galantamine (Razadyne) Benefits Used for mild/moderate Alzheimer’s Proven to slow cognitive decline in patients for up to 36 months Stimulates release of Acetylcholine Side Effects Nausea Vomiting Rare cardiac events in some patients

16. Why Fund these Treatments? They are temporary, but have shown improvement for past patients. Proven to lessen severity of symptoms. Treat symptoms of memory loss, reasoning, language, and thinking. Use for patients in mild to moderate stages. Keeps hospitalizations down. More aware and productive. Better family dynamic.

18. References Alzheimer's Association. (2012, January). FDA-Approved Treatments for Alzheimer's. Retrieved from https://www.alz.org/national/documents/topicsheet_treatments.pdf Alzheimer’s Association. (2015a). Risk factors. Retrieved from http://www.alz.org/alzheimers_disease_causes_risk_factors.asp Alzheimer’s Association. (2015b). Stages of Alzheimer’s. Retrieved from http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp#overview Auriacombe, S., Pere, J., Loria-Kanza, Y., & Vellas, B. (2002). Efficacy and Safety of Rivastigmine in Patients with Alzheimer's Disease who Failed to Benefit from Treatment with Donepezil. Current Medical Research and Opinion, 18(3), 129-138. Retrieved from http://informahealthcare.com/doi/abs/10.1185/030079902125000471 B irks, J. (2006). Cholinesterase inhibitors for Alzheimer's Disease. Cochrane Database System Review, 1. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16437532 Birks, J., & Melzer, D. (2003). Donepezil for mild and moderate Alzheimer's disease. The Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001190 Mayeux, R., & Sano, M. (1988). Treatment of Alzheimer's disease. The New England Journal of Medicine, 662(1), 17-18. doi:10.1007/bf03309184 Mayo Clinic. (2014). Alzheimer’s disease. Retrieved from http://www.mayoclinic.org/diseases- conditions/alzheimers-disease/basics/risk-factors/CON-20023871 Mayo Clinic. (2014a, July 11). Alzheimer's: Drugs helps manage symptoms. Retrieved from http%3A%2F%2Fwww.mayoclinic.org%2Fdiseases-conditions%2Falzheimers-disease%2Fin-depth%2Falzheimers%2Fart-20048103 National Center for Policy Analysis. (2007). Cost of Alzheimer’s care to rise. Retrieved from http://www.ncpa.org/sub/dpd/index.php?Article_ID=14331