Alzheimer disease / Dementia (chronic organic brain syndrome)/

Question 1

Features

Answer 1

There is no known cure for dementia:

—the second commonest cause of death

—tender loving care and behavioural interventions, especially repeated cognitive training and exercises, are important.

Assess with the mental state examination

• Mini-mental state examination

Question 2

Drugs available for Alzheimer disease (modest efficacy)

Answer 2

Cholinesterase inhibitors:

• donepezil 5 mg (o) nocte 4 wks, ↑ 10 mg nocte or
• galantamine 4 mg (o) bd 4 wks, ↑ 8 mg bd or
• rivastigmine 1.5 mg (o) bd 2 wks, ↑ 6 mg bd

Asparate (NMDA antagonist):

• memantine 5 mg (o) mane 1 wk, ↑ 5 mg bd wk 2, ↑ 10 mg bd

To control psychotic symptoms or disturbed behaviour:

Psychotropic medication is often not required.

• risperidone 0.5–2 mg (o)/d or
• quetiapine (recommended) or
• olanzapine

To control symptoms of anxiety and agitation:

• oxazepam 15 mg (o) 1–4 times/d (short-term use)

Antidepressants for depression—citalopram preferred.