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For most Americans, the words “Alzheimer’s disease” (AD) – often mispronounced purposefully or accidentally

as “old timers’ disease” – signify devastating memory loss and stigma. The information about AD – often

learned solely through the media – may lead individuals to believe that AD is inevitable (it isn’t), and possibly

think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may

envision a future burdened with more dementia patients and fewer societal resources to help support them (a

real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly

progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent

information about AD’s myths, realities, and available symptomatic treatments. AD’s harbinger is language

difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and

agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for

items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or

severe depending on the patient’s cognitive and memory impairment, communication problems, personality

changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive

decline or senility – in other words, “normal” aging. For this reason, most people don’t seek treatment and are

diagnosed in the late-mild to early-moderate stage. In the severe stage, difficulty swallowing elevates the risk of

aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death;

AD has no cure. A handful of pharmacologic treatments – acetylcholinesterase inhibitors and N-methyl-Daspartate antagonists – alter the decline trajectory. These treatments slow disease progression, enhance

cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these

medications, but experts generally believe that those who do will show mild to moderate improvements for 6

months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly

enable independence. Determining when medications stop providing a therapeutic benefit and should be

discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools,

patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to

tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific

behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns.

Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective

behavioral strategies are much preferred.

The author’s attitude toward Alzheimer’s disease is best summarized by which of the following?

Critical of the treatment methods utilized by health care professionals.

What is the oxidation state of each nickel on the reactant side of the following reaction?

2 NiO(OH) + Cd + 2 H2O –> 2 Ni(OH)2 + Cd(OH)2

Coughs that linger after a cold or sinus problem cause constant disruption in the home, school, and workplace.

Often, these dry, nonproductive coughs become increasingly troublesome although other symptoms – fever,

congestion, and fatigue – resolved days or weeks ago. This stubborn cough persists for weeks, and plagues its

victim and the victim’s family night and day. The diagnosis might be a common, but overlooked cause of

lingering cough: atypical pneumonia caused by mycoplasma. Mycoplasma – pleomorphic bacteria that lack a

cell wall – are the smallest and simplest self-replicating organisms known to humans. They probably evolved

from gram-positive, walled eubacteria by degenerative evolution. Smaller than amoebas, these 0.1-micrometer

organisms grow and reproduce slowly and require no oxygen or host cell. They also change shapes

asymmetrically, appearing as long, thin filaments, tiny spheres, or branches. Scientists have identified more

than 100 mycoplasma species. Fifteen species are known to live in humans, most as normal symbiotic flora.

Mycoplasma pneumoniae, previously called “walking pneumonia,” is pathogenic in humans. Mycoplasma

pneumoniae glides freely and uses its specialized filamentous tips to burrow between cilia within the respiratory

epithelium, causing the respiratory epithelial cells to slough. It also produces hydrogen peroxide, which causes

initial cell disruption in the respiratory tract and damages erythrocyte membranes. Researchers have

determined that more than 40% of infants younger than 1 year old have had a mycoplasma infection. By age 5,

approximately 65% of children have been infected. Nearly all adults have been infected at least once, often

repeatedly. Mycoplasma pneumonia usually affects people younger than 40 years of age. The highest

incidence is found in the 5- to 9-year age group. The risk of contracting mycoplasma pneumonia is greatest for

people who live or work in crowded areas, such as daycare facilities, schools, homeless shelters, long-term

care units, and military and prison environments. However, many people who develop mycoplasma infections

have no identifiable risk factor. Most mycoplasma infections cause mild to moderate clinical symptoms, but the

infection incubates over 3 weeks and can last weeks without treatment. This infection cannot be diagnosed

based on symptoms alone; laboratory testing is essential. Infection can also cause ear infections, sinus

infections, bronchitis, croup, severe sore throats, infectious asthma, and 1 type of the common cold. When

mycoplasma infects children, about 25% of them develop nausea, vomiting, or diarrhea.

Which of the following is NOT true about mycoplasma infection?

It has an incubation period of over three weeks.

It can be diagnosed without laboratory testing.

It can cause nausea, vomiting, or diarrhea in children.

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