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AAD Flashcards

1
Q

What is the prevalence of agitation in Alzheimer’s disease?

A

30 to 50%

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2
Q

What is the prevalence of agitation in dementia with Lewy bodies?

A

30%

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3
Q

What is the prevalence of agitation in frontotemporal dementia?

A

40%

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4
Q

What is the prevalence of agitation in vascular dementia (VaD)?

A

40%

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5
Q

What brain regions are primarily involved in the pathophysiological mechanism underlying agitation?

A

Frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC).

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6
Q

What is a trigger for agitation in dementia patients, related to environmental factors?

A

Low light environments, as in the sundown syndrome, hospitalization, or changes in pharmacological regimens.

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7
Q

How is the frontal lobe dysfunction confirmed in relation to agitation?

A

Through functional imaging studies in both cognitively unimpaired subjects and Alzheimer’s Disease patients.

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8
Q

What neurotransmitter systems are imbalanced in the onset of behavioral impairments?

A

Cholinergic and noradrenergic systems.

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9
Q

When should pharmacological treatments for agitation be initiated?

A

When behavioral changes may compromise patient safety and produce severe distress to caregivers.

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10
Q

What factors can generate agitated behavior in dementia patients?

A

Chronic or acute pain, sleep disturbances, sensory impairment, acute medical illnesses, or metabolic changes.

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11
Q

What can trigger acute onset of agitation in dementia patients?

A

Changes in medication regimens or drug side effects.

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12
Q

Which scales are used to assess agitation in clinical settings?

A

Agitated Behavior Scale (ABS), Behavioral Activity Rating Scale (BARS), Overt Agitation Severity Scale (OASS), Modified Overt Aggression Scale (MOAS), Pittsburgh Agitation Scale (PAS).

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13
Q

What is the recommendation on the use of antipsychotics in dementia patients with agitation?

A

Use atypical antipsychotics only after non-pharmacological measures fail and in cases of severe self-harm or harm to others.

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14
Q

What side effects warrant discontinuation of antipsychotics in dementia patients?

A

Cessation of behavioral disturbances or occurrence of side effects.

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15
Q

What is the role of SSRIs in treating agitation in Alzheimer’s disease?

A

SSRIs like citalopram, escitalopram, and sertraline have demonstrated efficacy in treating dementia-related agitation.

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16
Q

How effective is trazodone in treating hyperkinetic delirium?

A

Low doses of trazodone (50–300 mg/day) showed some effectiveness in treating hyperkinetic delirium.

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17
Q

What outcomes have studies shown for AChEIs like donepezil in delirium treatment?

A

Some case reports and one open-label study suggested promising results, but further evidence is needed.

18
Q

What are the effects of atypical antipsychotics on patients with dementia experiencing agitation?

A

They show comparable effectiveness and higher patient tolerance in reducing symptoms of psychosis, aggressiveness, or agitation.

19
Q

What are the risks associated with typical and atypical antipsychotics in patients with cardiac disease?

A

They should be avoided due to pro-arrhythmogenic effects like QT interval prolongation.

20
Q

What benefits have been observed with the use of cannabinoids for treating agitation in dementia?

A

Cannabinoids like dronabinol have shown effects on nighttime agitation.

21
Q

What is a common difficulty faced by patients with dementia regarding basic needs?

A

Many patients with dementia struggle with eating or swallowing and often develop insomnia.

22
Q

What is the initial recommended treatment for mild-moderate dementia if a cholinesterase inhibitor hasn’t been started?

A

For mild-moderate dementia, it is recommended to begin treatment with donepezil.

23
Q

What combination therapy is considered for moderate to severe dementia?

A

High-dose donepezil in conjunction with memantine is considered for moderate to severe dementia.

24
Q

Which medication has been found to reduce hallucinations in patients with Lewy Body Dementia (LBD)?

A

Rivastigmine has been shown to reduce hallucinations in patients with LBD.

25
Q

How did patients with mild-to-moderate Alzheimer’s disease (AD) respond to memantine or rivastigmine compared to donepezil or galantamine in a 2014 study?

A

Patients receiving memantine or rivastigmine showed more improvement in Behavioral and Psychological Symptoms of Dementia (BPSD) than those receiving donepezil or galantamine.

26
Q

What was the outcome of using rivastigmine patches and memantine in treating aggression in AD patients?

A

No improvement was observed in aggressive behaviors, but there was significant improvement in non-aggressive agitation.

27
Q

Which type of antidepressant has a substantial evidence base for treating dementia-related agitation?

A

Selective Serotonin Reuptake Inhibitors (SSRIs), such as citalopram or sertraline, have the largest evidence base.

28
Q

What serious side effects are associated with citalopram in dementia patients?

A

Citalopram can lead to QT prolongation and worsening of cognition at 30 mg/day dosing.

29
Q

What potential risk does trazodone present when used for insomnia in dementia patients?

A

Trazodone may cause orthostatic hypotension.

30
Q

Why are benzodiazepines generally not recommended for dementia patients?

A

Benzodiazepines increase the risk of falls, delirium, and behavior disinhibition.

31
Q

Which antipsychotic medications have shown improvement in severe agitation and psychosis in AD patients?

A

Risperidone, aripiprazole, and olanzapine have been effective in managing severe agitation and psychosis.

32
Q

What caution should clinicians exercise when using antipsychotics for BPSD in dementia?

A

Clinicians should consider tapering or discontinuing antipsychotics after control of BPSD to mitigate associated risks.

33
Q

How does insomnia and sleep disturbances impact patients with dementia?

A

Insomnia and sleep disturbances contribute to the symptoms of BPSD.

34
Q

Why is diphenhydramine considered a poor choice for treating insomnia in dementia patients?

A

Diphenhydramine increases the risk of falls and can cause residual sleepiness and anticholinergic symptoms like constipation and dry mouth.

35
Q

What ongoing trial as of August 2018 is investigating a potential treatment for aggression in dementia?

A

A clinical trial is investigating whether lithium is an effective treatment for aggression in older adults with moderate to severe AD.

36
Q

What is the first line of therapy when treating mild to moderate Alzheimer’s disease?

A

The first line of therapy is typically a cholinesterase inhibitor, such as donepezil.

37
Q

What is a significant finding of the CitAD study regarding the use of citalopram for dementia patients?

A

The CitAD study found that citalopram significantly decreased agitation and caregiver burden.

38
Q

What should be considered when prescribing tricyclic antidepressants or SSRIs to older adults?

A

The increased fall risk must be considered; starting at a low dose and titrating slowly is important to minimize risks.

39
Q

What symptom improvement was noted in AD patients using memantine or rivastigmine according to a 2014 crossover study?

A

There was more improvement in behavioral and psychological symptoms compared to those on donepezil or galantamine.

40
Q

Which medication reduces hallucinations specifically in patients with Lewy Body Dementia?

A

Rivastigmine effectively reduces hallucinations in Lewy Body Dementia due to a greater cholinergic deficit compared to Alzheimer’s Disease.

AI Generated (2 decks)

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