Chapter 4: Nervous System Flashcards
1. Dementia 2. Epilepsy & other seizure disorders 3. Mental health disorders 4. Movement disorders 5. Nausea and labyrinth disorders 6. Pain 7. Sleep disorders 8. Substance dependence
What is dementia?
Dementia is an umbrella term used to describe a range of medical conditions that involve the deterioration of cognitive function incl memory, thinking and behaviour.
List the top causes of dementia?
- Alzheimerโs disease
- Dementia with Lewy bodies
- Vascular dementia
- Frontotemporal dementia
What is the most common cause of dementia?
Alzheimerโs disease
What is Alzheimerโs disease
- Thought to be caused by the abnormal build up of 2 proteins; amyloid and tau.
- Amyloid deposit and form plaques outside the brain cells and the taus form tangles inside the cells. These eventually damage the brain cells and cause them to die.
- People with alzheimerโs are found to have extremely low levels of acetylcholine neurotransmitters.
What is dementia with Lewy bodies
Where tiny clumps of protein called alpha-synuclein develop inside the brain cells and damage the way the cells work and communicate with each other.
What is vascular dementia
Caused by reduced blood flow to the brain which damages and eventually kills brain cells. This can happen as a result of narrowing and blockage of small blood vessels inside the brain, stroke or mini strokes.
What is frontotemporal dementia.
Caused by abnormal clumping of proteins including tau in the frontal and temporal lobes at the front and sides of the brain. These clumping damages nerve cells causing the brain cells to die. This leads to shrinking of these areas of the brain.
What is the first line of treatment for patients newly diagnosed with mild -moderate Alzheimerโs disease?
What is the alternative if they are not tolerated?
Monotherapy with acetylcholinesterase inhibitors:
โข Donepezil
โข Galantamine
โข Rivastigmine
(These 3 are acetylcholinesterase inhibitors).
if above not tolerated โ Memantine
What is recommended for patients newly diagnosed with severe Alzheimerโs ?
Monotherapy with:
โข Memantine
What should be considered when treatment for dementia is initiated?
acquisition cost (treatment should be started with the lowest acquisition cost drug (considering dose and price per dose).
Which medicine should be given to patients who have an established diagnosis of Alzheimerโs disease and are already on AChE inhibitors?
Consider addition of memantine
Which unlicensed medicines should be given to patients with mild/moderate dementia with lewy bodies ?
And the alternative if they are not tolerated?
donepezil or rivastigmine (unlicensed)
if above not tolerated โ Galantamine (unlicensed)
if AChEi not tolerated โ memantine
Which unlicensed medicines should be given patients with severe lewy bodies dementia ?
Donepezil or rivastigmine
memantine ( if AChEi not tolerated)
Which patients should NOT be offered AChEi ?
Patients with:
- Frontotemporal dementia
- Cognitive impairment caused by MS
- Vascular dementia unless they have suspected comorbid Alzheimer disease, Parkinsons dementia disease of dementia with lewy bodies.
Describe the dosing for donepezil
Initially 5mg OD for 1 month then increase if necessary to 10mg OD.
