dementia Flashcards
what is dementia
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
what is alzheimer’s disease
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
what is the aim of dementia treatment
promote independence, maintain function, and manage symptoms of dementia
what non-drug treatment should be provided to patients with any type of mild-to-moderate dementia presenting with cognitive symptoms
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
what are the cognitive symptoms of dementia
- memory loss
- confusion
- difficulty carrying out familiar daily tasks
- mood changes
what is the first line treatment for newly diagnosed mild-to-moderate Alzheimer’s disease
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*
why are acetylcholinesterase inhibitors useful in treating dementia symptoms
give examples of acetylcholinesterase inhibitors
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
what is the first line treatment of severe alzheimer’s disease
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
TRUE OR FALSE
stopping acetylcholinesterase inhibitor treatment can cause worsening of cognitive function
TRUE
when would you consider adding memantine to a patient already taking a acetylcholinesterase inhibitor
if they develop moderate or severe disease
note this doesn’t have be done by specialist clinician. can be done in primary care
when should you NOT use acetylcholinesterase inhibitors or memantine
patients with:
- frontotemporal dementia
- cognitive impairment caused by multiple sclerosis
what is the first line treatment for dementia with Lewy bodies (mild, moderate + severe)
- acetylcholinesterase inhibitors : Donepezil hydrochloride or rivastigmine first line
what are the non-cognitive symptoms of dementia
Agitation, aggression, distress and psychosis
what is the first line treatment to manage non-cognitive symptoms of dementia
psychosocial and environmental interventions such as counselling and management of pain and delirium to reduce distress
when should you offer antipsychotics to manage non-cognitive symptoms of dementia
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