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845 > Alzheimer's + Other Dementias > Flashcards

Alzheimer's + Other Dementias Flashcards

1
Q

Dementias

A
  • Mild Cognitive Impairment (MCI)
  • Alzheimer’s Disease (AD)
  • Vascular Dementia
  • Dementia with Lewy Bodies (PD)
  • Mixed Dementia: Vascular + AD
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2
Q

Alzheimer’s Presentation

A
  • Impaired recent memory
  • Word finding
  • Memory recognition
  • Apraxia
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3
Q

Vascular Dementia Presentation

A
  • General intellectual decline over time
  • Memory disturbance
  • Executive dysfunction
  • Apathy
  • Possible gait disturbance
  • Visual field loss
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4
Q

Lewy Body Dementia Presentation

A
  • Fluctuating Cognition
  • Recurrent detailed visual hallucinations
  • Spontaneous motor features of PD
  • Sensitivity to neuroleptics
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5
Q

PD Dementia Presentation

A
  • Memory preserved early
  • Later impaired speech
  • Apathy
  • Irritability
  • Depressive features
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6
Q

Delirium

A
  • Sudden alterations in cognitive function, can fluctuate during day
  • Attention span impairment
  • Often accompanied by disturbances in sleep-wake cycle and psychomotor disturbances
  • Underlying pathologies: UTI, MI, pneumonia, pain
  • Could be drug induced as well
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7
Q

DELIRIUM-PP

A 
Potential causes of delirium:
D-dehydration/renal failure
E- Electrolytes/metabolic
L- Low oxygen
I - Infection
R- Retention (stool/urine)
I-Ischemia/infarction
U - NeUrologic (CVA, encephalitis)
M - Medications (new, changed, DCed)
P - Pain
P - Physical restraints
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8
Q

Conditions + Dementia-like Symptoms

A
  • Depression
  • Hypothyroidism
  • Vitamin B12 Deficiency
  • Alcohol
  • Trauma
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9
Q

Dementia Occurances

A
  • Forgets entire experiences
  • Rarely remembers experiences later
  • Gradually unable to follow written/spoken directions
  • Gradually unable to use notes as reminders
  • Gradually unable to care for self
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10
Q

Functional Staging Assessment

A
  1. No difficulties
  2. Subjective forgetfulness
  3. Decreased job functioning and organizational capacity
  4. Difficulty with complex tasks, instrumental ADLs
  5. Requires supervision with ADLs
  6. Impaired ADLs, with incontinence
  7. Severe, late disease
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11
Q

Stage 7 Characteristics

A 
A. Ability to speak limited to six words
B. Ability to speak limited to single word
C. Loss of ambulation
D. Inability to sit
E. Inability to smile
F. Inability to hold head up
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12
Q

AD + Morbidity/Mortality

A
  • Initial stages: cognitive deficits and neuropsychiatric symptoms
  • Final stages often result in placement in a long-term care facility
  • Choking, aspiration, and infection are events that generally result in death for this population
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13
Q

MCI Treatment

A
  • No medication
  • Consider reversible causes
  • Stay physically/mentally active
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14
Q

AD Treatment Guidelines

A
  • Use pharmacologic and nonpharm approaches
  • Goal: maintain patient functioning for as long as possible
  • Secondary goal: treat psychiatric and behavioral sequelae
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15
Q

AD + Nonpharm

A
  • Patient/caregiver education
  • Considering reversible causes of delirium/dementia (depression, infection)
  • Reassurance and distraction
  • Maintaining routines
  • Music, exercise, gardening
  • Touch therapy
  • Pet therapy
  • Behavioral Interventions
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16
Q

Mild - Moderate AD + Pharm

A
  • MoCA: 18-26 for mild, 10-17 moderate
  • Cholinesterase inhibitors, titrate as tolerated
  • EX: Donepezil, galantamine, rivastigmine
17
Q

Moderate - Severe AD + Pharm

A
  • MoCA: Severe < 10
  • Consider adding memantine, titrate as tolerated
  • Can use memantine or cholinesterase inhibitor monotherapy as well
18
Q

Evaluating Medication Response

A
  • Successful treatment results in a <2 point drop MoCA score per year
  • For ADAS-Cog, halting progression or improving over 6mo+ is considered a good response
19
Q

Vascular Dementia

A
  • Risk Factors: Diabetes, HTN, Hyperlipidemia

- May use similar agents to Alzheimer’s Disease

20
Q

Lewy Body Dementia Treatment

A
  • Early loss of attention, executive fxn, and visuospatial
  • Treatment: AChE inhibitors, Memantine??
  • PD Treatment: AChE Inhibitors, Rivastigmine (FDA Approved), Memantine
21
Q

BPSD Approaches

A
  • Behavioral and Psychological Symptoms of Dementia
  • Identify target symptom and environmental factors possible associated
  • Identify possible underlying medical causes and incorporate nonpharm first
  • Educate caregivers
  • Treat selected symptoms with medication and give realistic treatment expectations
22
Q

BPSD Medications

A
  • None approved to treat BPSD
  • Atypical antipsychotics (low dose) - increased mortality risk
  • Antidepressants: avoid TCAs and possible suicide risk with SSRIs in elderly
  • Mood stabilizers: valproic acid, lithium
  • Benzos: possible disinhibition and increased cognitive function
  • Neudexta: helps with agitation and behavior in AD, only FDA approved for pseudobulbar affect
23
Q

Cholinesterase Inhibitors

A
  • For mild to severe AD
  • Similar efficacy, cost is main divider
  • Caution: anticholinergic drugs
  • Donepezil: frequently used first line, daily dosing, well-tolerated, minimal P450 interactions
  • Rivastigmine: no P450 interactions
  • Slows down rate of decline, not a cure
  • May reduce behavioral symptoms, probably stabilizes AD, shown to improve in cognitive/physician assessments
24
Q

AChE-I AE

A
  • N/V
  • Diarrhea
  • Anorexia
  • Dizziness
  • Dyspepsia
  • Agitation
  • Severe: SJS (discontinue at first sign)
25
Q

AChE-I + Cautions

A
  • Bardycardia: monitor when on other meds that decrease heart rate
  • Ulcers: increased gastric acid secretion
  • COPD/Asthma: bronchoconstriction
  • Urinary tract obstruction
  • Exaggerate succinylcholine neuromuscular blockade during anesthesia
26
Q

NMDA Antagonist

A
  • Memantine
  • Moderate to severe AD
  • Reduce doses in patients with renal impairment (5 mg BID)
  • Caution with other NMDA-antagonists
  • May offer benefits in behavioral disturbances
  • Generally well tolerated
27
Q

Florbetapir

A
  • Detects presence of amyloid plaque in brain with PET scan

- Approved by FDA in 2012

28
Q

NeuroAD

A
  • Transcranial magnetic stimulation

- Lack of efficacy data kept FDA from approving it

845 (24 decks)

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