Delirium Flashcards
What are the three major categories of non-cognitive (“behavioral”) sx
Psychotic (delusions, hallucinations)
Undesired or disruptive behavior (aggression, agitation)
Depression
What is the general approach for alzheimer’s dementia?
Try it! If it doesn’t work, try again, try something different, evaluate your approach to determine if you did a good job with implementation, you may have tried it at the wrong time or the wrong way
Are there any psychotropic meds that are w/o AEs in elderly patients?
No
How do we choose which psychotropic med we give to a specific patient
Match it to their sx
When do we start psychotropic meds?
Only when they have mod-severe symptoms
What is sun downing syndrome?
Associated with worsening cognition/behavior at night
What are potential causes of sun downing?
Fatigue
Lighting
Changes in internal clock
Difficulty separating dreams from reality
What can also occur with confusion in sun downing?
Anxiety
Aggression
Non-cooperation
What can sun downing lead to?
Pacing or wandering
What are the non-cognitive sx behavioral variant of FTD?
Behavioral disinhibition
Apathy/inertia
Loss of sympathy/empathy
Preservative, stereotyped or compulsive/ritualistic behavior
What are treatment options for FTD?
SSRIs for disinhibition-impulsivity
Low doses of trazodone or atypical antipsychotics for agitation
D/t EPS, depot forms, conventional agents, and risperidone should be avoided
Cognitive enhancers have not been found to be useful
What is the key feature in LBD and PD?
Fluctuations in attention and alertness
What is a diagnostic sign of LBD?
Severe sensitivity to neuroleptic (antipsychotic) agents
What is a prominent non-cognitive sx in patients w/LBD or PD?
Hallucinations
What type of medication should be avoided in patients with LBD or PD?
Antipsychotics
What do the non-cognitive sx depend on?
Location of lesions
What is common in vascular dementia?
Depression and apathy are common
Sexual inappropriate behavior
Agitation and aggression occur as well
Use therapies that are targeted to the symptoms the patient is having
Is there an FDA indication for antipsychotics in treating non-cognitive symptoms of dementia?
No
What non-cognitive sx are antipsychotics moderately effective for?
Psychosis (Hallucinations, Delusions,Suspiciousness) Disruptive behaviors (agitation, aggression)
What are BBW for antipsychotics?
Increased mortality in those with dementia
What is an increased risk of antipsychotics?
QT prolongation
What are side effects of atypical antipsychotics?
Hyperglycemia
Dyslipidemia
Weight gain
EPS/Parkinsonism is a side effect of antipsychotics in what two problems?
LBD or dementia associated with PD
What is a conventional antipsychotic?
Haloperidol
What are the atypical antipsychotics?
Olanzapine Quetiapine Risperidone Aripiprazole Ziprasidone
What agents are preferred in Parkinson’s associated dementia?
Clozapine (clozaril)
Quetiapine (Seroquel)
Pimavanserin (NuPlazid)
What is the MOA of Clozapine?
Blocks the DA 1 and 4 receptor subtypes (do not see EPS in this one)
Blocks serotonin type 2 receptor
Increases GABA turnover which inhibits DA neurons
What is the MOA of quetiapine?
Potent 5HT2 receptor blocker and only moderate D2 blockade
Lower risk of EPS than rest
What is Pimavanserin indicated for?
PD associated psychosis
When do we avoid Pimavanserin?
CrCl < 30
Combination with 3A4 inhibitors/inducers
Why does Pimavanserin not worsen motor symptoms like other atypical antipsychotics?
Does not block DA receptor
What is the efficacy of anticonvulsants in non-cognitive sx of dementia?
minimal to modest
What is the anticonvulsant drug used in non-cognitive sx of dementia?
Valproic acid 500-1200mg/d
For what sx do benzos show efficacy in non-cognitive sx of dementia?
Agitation
Aggression
Anxiety
