Dementia Flashcards
What is dementia?
Dementia is the loss of cognitive functioning - thinking, remembering, and reasoning - to such an extent that it interferes with a person’s daily life and activities.
What are the main types of dementia?
Alzheimer’s.
Vascular.
Lewy Body.
What is Alzheimer’s?
A brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks.
Those with the late-onset type symptoms first appear in their mid-60s.
What is vascular dementia?
Vascular dementia is a common type of dementia caused by reduced blood flow to the brain.
Symptoms of vascular dementia include confusion, slow thinking and changes in your mood or behaviour.
What is lewy body dementia?
Lewy body dementia (LBD) is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain.
These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood.
What do the NICE guidelines say about diagnosing dementia?
CT scan.
History taking.
Blood tests.
Cognitive and mental state examination.
Review of medication including any over the counter medication that may adversely affect cognitive function.
What are cholinesterase inhibitors?
Cholinesterase inhibitor drugs stop or inhibit enzymes from breaking down acetylcholine when it travels from one cell to another.
What are the side effects of cholinesterase inhibitors?
Nausea, vomiting, diarrhoea.
Difficulty urinating/ incontinence.
Slow pulse, dizziness, hypotension.
What base line tests are required for patients starting cholinesterase inhibitors?
Baseline ECG is required for all patients.
Regular check of pulse during titration.
Then do these every 6 monthly alongside blood pressure checks.
What is memantine?
This is a NMDA antagonist (N Methyl D Aspartate) receptor antagonist.
Memantine targets the excitatory amino acid glutamate which is thought to be chronically raised in dementia.
Available as oral solution and tablet.
Used in moderate to severe Alzheimer’s.
Can be co-prescribed with acetylcholinesterase inhibitors due to novel mode of action.
What are the side effects of memantine?
Somnolence (not enough stimulation).
Exhaustion (not enough stimulation).
Headache.
Constipation.
Dizziness.
Memantine is also related to LSD so some people can get hallucinations.
What is donepezil?
Cholinesterase inhibitor.
Comes as tablets and oral dispersible tablets.
Given once a day.
Side effects include diarrhoea, muscle cramps , fatigue vomiting, insomnia and dizziness.
Should be used in caution with patients with asthma and COPD or peptic ulcer disease.
If you miss it for more than one week then re-titerate.
What is rivastigmine?
Cholinesterase inhibitor.
Comes as capsule, liquid, and transdermal patch.
Useful in patients who need slow titration.
Twice daily dosing.
Side effects and caution as for donepezil.
If you miss it for more than seven-day re-titrate.
What is galantamine?
Cholinesterase inhibitor.
Only available as a liquid and tablets and long acting tablets.
Derived from daffodils.
Used in mild to moderate disease.
If missed more than five days re-titerate.
Under what conditons can cholinesterase inhibitors be precribed?
NICE Guidelines:
Alzheimer’s disease must be diagnosed and treatment initiated by a specialist; treatment can be continued by general practitioners under a shared-care protocol.
The carer’s view of the condition should be sought before and during treatment.
Treatment should continue only if it is considered to have a worthwhile effect on cognitive, global, functional, or behavioural symptoms.
Healthcare professionals should not rely solely on assessment scales to determine the severity of Alzheimer’s disease when the patient has learning or other disabilities, or other communication difficulties.
