CHAPTER 4: CNS: Dementia

Question 1

What is the non-pharmacological treatment for mild to moderate dementia with cognitive symptoms?

Answer 1

Structured group stimulation programmes

Question 2

Can a GP initiate and supervise dementia pharmacological treatment?

Answer 2

No - specialist initiation and supervision

Question 3

Which drugs are recommended to manage the cognitive symptoms of mild to moderate dementia due to Alzheimer’s disease?

Answer 3

1. Donepezil
2. Rivastigmine
3. Galantamine

Question 4

Donepizil, Rivastigmine and Galantamine all belong to which drug class?

Answer 4

Acetylcholinesterase inhibitors

Question 5

What is the drug of choice to manage the cognitive symptoms severe Alzheimer’s disease?

Answer 5

Memantine

Question 6

As well as in severe Alzheimer’s disease, when else is memantine suitable?

Answer 6

As an alternative to for patients with moderate Alzheimer’s disease when acetylcholinesterase inhibitors are contra-indicated or not tolerated

Question 7

What is the drug of choice to manage the cognitive symptoms of vascular dementia?

Answer 7

Pharmacological treatment is not recommended

Question 8

What is the treatment recommendation for patients with non-cognitive symptoms such as anxiety or delusions?

Answer 8

Non-pharmacological interventions such as multisensory stimulation or aromatherapy should be tried for less severe symptoms

Question 9

Should patients with mild to moderate non-cognitive symptoms (anxiety, delusion etc) be prescribed antipsychotics?

Answer 9

NO

Question 10

Should patients with severe non-cognitive symptoms (anxiety, delusion etc) be prescribed antipsychotics?

Answer 10

Yes, after careful consideration

Question 11

In 2009, what did the MHRA report a clear increased risk of in elderly patients with dementia taking antipsychotic drugs?

Answer 11

Stroke (and death)

Question 12

Before being prescribed an antipsychotic for severe non-cognitive symptoms of dementia, which risk factors for cerebrovascular disease should be considered? (4)

Answer 12

1. History of stroke or TIA
2. Diabetes
3. Hypertension
4. AF

Question 13

Patients with DLB taking antipsychotics for non-cognitive symptoms should be assessed for severe untoward reactions such as?

Answer 13

Neuroleptic sensitivity reactions

Question 14

Can acetylcholinesterase inhibitors and memantine also be used to treat non-cognitive symptoms of Alzheimer’s Disease and DLB?

Answer 14

Yes

Question 15

Can acetylcholinesterase inhibitors be used in vascular dementia?

Answer 15

No, not recommended

Question 16

As well as for severe non-cognitive symptoms (anxiety, delusions etc), when else can antipsychotics be used in dementia?

Answer 16

To manage behavioural symptoms of violence, aggression and extreme agitation

Question 17

Benzodiazepines can be used to manage behavioural symptoms of violence, aggression and extreme agitation. Through which routes can the be administered?

Answer 17

1. Oral
2. Intramuscular
3. IV (special circumstances

Question 18

For the intramuscular administration of benzodiazepines to manage behavioural symptoms of violence, aggression and extreme agitation, which are the ones recommended? (3)

Answer 18

1. Lorazepam
2. Haloperidol
3. Olanzapine

Question 19

Are diazepam and chlorpromazine recommended for behavioural symptoms of violence, aggression and extreme agitation?

Answer 19

NO

Question 20

Acetylcholinesterase inhibitors can cause unwanted dose-related cholinergic effects, give some symptoms of this (5)

Answer 20

1. Excessive sweating
2. Involuntary defaecation and urination
3. Increased production of saliva
4. Bradycardia
5. Hypotension

Question 21

Which serious skin reaction has galantamine been associated with?

Answer 21

Steven-Johnson Syndrome

Question 22

What should patients be counselled to do if they experience any skin reactions while taking galantamine?

Answer 22

Stop taking and seek medical advice

Question 23

What is a side effect of rivastigmine less associated with transdermal administration?

Answer 23

GI effects

Question 24

What should happen if a patient taking rivastigmine experiences GI effects?

Answer 24

Drug should be witheld then re-titrated (if necessary) on resolution