CNS - DEMENTIA

Question 1

What are some cognitive symptoms of dementia?

Answer 1

• Memory loss
• Difficulties thinking
• Language
• Orientation

Question 2

What is used to manage COGNITIVE symptoms?

Answer 2

AChE inhibitors

• Donepezil - can cause neuroleptic malignant syndrome (rare). Risk increases if taken with antipsychotics
• Galantamine - Can cause serious skin reaction (SJS), stop at first appearance of skin rash
• Rivastigmine - Causes GI disturbances but can be given transdermally to avoid

In moderate to severe dementia

• Memantine

Question 3

What are the side effects of AChEi’s?

Answer 3

DUMBBELS

• Diarrhoea
• Urination
• Muscle weakness, cramps, miosis (pupil constriction)
• Bronchospasm
• Bradycardia
• Emesis (vomiting)
• Lacrimation (teary eyes)
• Salivation/Sweating

Question 4

What are some non-cognitive symptoms?

Answer 4

• Psychiatric and behavioral problems e.g. delusions or aggression
• difficulties with daily activities

Question 5

What is used to manage NON-COGNITIVE symptoms?

Answer 5

• Antipsychotics - use with caution in elderly
• Extreme violence, aggression, agitation = Oral benzos or antipsychotics. If IM for behavioral control = haloperidol, olanzapine, lorazepam
• Dementia with lewy body (parkinsons) = Rivastigmine only