dementia Flashcards

1
Q

what is dementia

A

a progressive disease made up of cognitive and behavioural symptoms that can include memory loss, problems with reasoning and communication, a change in personality, and a reduced ability to carry out daily activities such as washing or dressing

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2
Q

what is alzheimer’s disease

A

the most common type of dementia which causes cognitive + behavioural symptoms

note other common types of dementia include vascular dementia (due to cerebrovascular disease), dementia with Lewy bodies, mixed dementia, and frontotemporal dementia

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3
Q

what is the aim of dementia treatment

A

promote independence, maintain function, and manage symptoms of dementia

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4
Q

what non-drug treatment should be provided to patients with any type of mild-to-moderate dementia presenting with cognitive symptoms

A

the opportunity to participate in a structured group cognitive stimulation programme. Group reminiscence therapy , cognitive rehabilitation or occupational therapy to support daily functional ability, should also be considered

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5
Q

what are the cognitive symptoms of dementia

A
  • memory loss
  • confusion
  • difficulty carrying out familiar daily tasks
  • mood changes
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6
Q

what is the first line treatment for newly diagnosed mild-to-moderate Alzheimer’s disease

A

monotherapy with donepezil hydrochloride, galantamine, or rivastigmine (acetylcholinesterase inhibitors)

  • if not tolerated mematinine
  • not newly diagnosed patients should only start drug treatment under specialist clinician*
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7
Q

why are acetylcholinesterase inhibitors useful in treating dementia symptoms

give examples of acetylcholinesterase inhibitors

A

in alzheimer’s, the patient has lower levels of acetylcholine (a neurotransmitter) and some of the nerve cells that use acetylcholine are lost. Reduced levels of acetylcholine causes symptoms.

  • acetylcholinesterase inhibitors prevent breakdown of acetylcholine which increases the amount of acetylcholine in brain, so better communication between nerve cells

examples= Donepezil, rivastigmine and galantamine

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8
Q

what is the first line treatment of severe alzheimer’s disease

A

memantine (glutamate receptor antagonist)

note in alzheimer’s, the nerve cells are damaged which produces too much glutamate. glutamate causes more damage to nerve cells so memantine blocks glutamate from binding to receptor. This blocks/stops the nerve damage caused by excess glutamate

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9
Q

TRUE OR FALSE

stopping acetylcholinesterase inhibitor treatment can cause worsening of cognitive function

A

TRUE

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10
Q

when would you consider adding memantine to a patient already taking a acetylcholinesterase inhibitor

A

if they develop moderate or severe disease

note this doesn’t have be done by specialist clinician. can be done in primary care

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11
Q

when should you NOT use acetylcholinesterase inhibitors or memantine

A

patients with:

  • frontotemporal dementia
  • cognitive impairment caused by multiple sclerosis
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12
Q

what is the first line treatment for dementia with Lewy bodies (mild, moderate + severe)

A
  • acetylcholinesterase inhibitors : Donepezil hydrochloride or rivastigmine first line
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13
Q

what are the non-cognitive symptoms of dementia

A

Agitation, aggression, distress and psychosis

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14
Q

what is the first line treatment to manage non-cognitive symptoms of dementia

A

psychosocial and environmental interventions such as counselling and management of pain and delirium to reduce distress

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15
Q

when should you offer antipsychotics to manage non-cognitive symptoms of dementia

A

only be offered to patients with dementia if:

  • they are either at risk of harming themselves or others, or
  • experiencing agitation, hallucinations or delusions that are causing them severe distress
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16
Q

describe the dose and duration of antipsychotic treatment to manage non-cognitive symptoms of dementia

A

Antipsychotic drugs should be used at the lowest effective dose and for the shortest time possible, with a regular review at least every 6 weeks

17
Q

In which types of dementia can the use of antipsychotics cause the motor symptoms to worsen

A
  • dementia with Lewy bodies
  • Parkinson’s disease dementia

antipsychotics may also cause severe antipsychotic sensitivity reactions in these 2 types of dementia

18
Q

how do you manage depression + anxiety in patients with dementia

A
  • Psychological treatments (e.g. cognitive behavioural therapy (CBT), multisensory stimulation, relaxation, or animal-assisted therapies) can be used in patients with dementia + mild-moderate depression/anxiety
  • antidepressants should be reserved for pre-existing severe mental health problems.
19
Q

how do you manage sleep disturbances in dementia

A

Patients should be offered non-drug treatment approaches to manage sleep problems and insomnia such as:

  • sleep hygiene education
  • exposure to daylight
  • increasing exercise and activity
20
Q

what is the MHRA warning about use of antipsychotics in patients with dementia

A
  • an increased risk of stroke and a small increased risk of death when antipsychotic drugs are used in elderly patients with dementia
  • The balance of risks and benefits should be carefully assessed, including any previous history of stroke or transient ischaemic attack and any risk factors for cerebrovascular disease such as hypertension, diabetes, smoking, and atrial fibrillation