dementia

Question 1

what is dementia

Answer 1

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

Question 2

what is alzheimer’s disease

Answer 2

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

Question 3

what is the aim of dementia treatment

Answer 3

promote independence, maintain function, and manage symptoms of dementia

Question 4

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

Answer 4

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

Question 5

what are the cognitive symptoms of dementia

Answer 5

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

Question 6

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

Answer 6

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*

Question 7

why are acetylcholinesterase inhibitors useful in treating dementia symptoms

give examples of acetylcholinesterase inhibitors

Answer 7

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

Question 8

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

Answer 8

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

Question 9

TRUE OR FALSE

stopping acetylcholinesterase inhibitor treatment can cause worsening of cognitive function

Answer 9

TRUE

Question 10

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

Answer 10

if they develop moderate or severe disease

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

Question 11

when should you NOT use acetylcholinesterase inhibitors or memantine

Answer 11

patients with:

• frontotemporal dementia
• cognitive impairment caused by multiple sclerosis

Question 12

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

Answer 12

• acetylcholinesterase inhibitors : Donepezil hydrochloride or rivastigmine first line

Question 13

what are the non-cognitive symptoms of dementia

Answer 13

Agitation, aggression, distress and psychosis

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

• dementia with Lewy bodies
• Parkinson’s disease dementia

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

Question 18

how do you manage depression + anxiety in patients with dementia

Answer 18

• 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.

Question 19

how do you manage sleep disturbances in dementia

Answer 19

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

Question 20

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

Answer 20

• 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