Dementia

Question 1

Dementia definition

Answer 1

a syndrome characterized by progressive decline of intellectual ability from a previously attained level (without alteration of consciousness

Question 2

Pathophysiologic causes of Dementia

Answer 2

• brain atrophy with ventricular enlargement
• degeneration of cholinergic and other neurons
• neurofibrillary tangles
• beta amyloid plaques

Question 3

How are neurofibrillary tangles formed?

Answer 3

tau alteration -> microtubule collapse -> tau proteins clump together

Question 4

Two most common causes of dementia symptoms

Answer 4

Alzheimer’s: 70%
Multi-infarct dementia: 10-20%

Question 5

Multi-infarct dementia (vascular dementia)

Answer 5

dementia caused by multiple strokes
stepwise deterioration

Question 6

Donepezil (Aricept)

Answer 6

MOA: AChE-I

Dosing: tablet, ODT
-5mg/day for 4-6 weeks -> 10mg/day for 3 months -> 23mg/day

ADE:
- symptomatic bradycardia
- rhabdomyolysis
- NMS

PK:
-t1/2 72hrs
- CYP 2D6 and 3A4 metabolism

Question 7

Rivastigmine (Exelon)

Answer 7

MOA: AChE-I
-capsule indicated for BOTH alzhiemer’s and Parkinson’s dementia

Dosing:
- capsule: 6-12mg/day
- patch: 4.6mg/24h -> 13.3mg/24h

Question 8

Rivastigmine (Exelon)

Answer 8

MOA: AChE-I
-capsule indicated for BOTH Alzheimer’s and Parkinson’s Dementia

Dosing:
- capsule: 6-12mg/day
- patch: 4.6mg/24h -> 13.3mg/24h

ADE: GI
-slow titration
-take with food

Question 9

Galantamine (Razadyne)

Answer 9

MOA: AChE-I
tablet, ER capsule, oral solution
mild-moderate AD

Question 10

Memantine (Namenda)

Answer 10

MOA: NMDA receptor antagonist

PK:
- food has no effect
-t1/2 60-80 hrs
- CYP independent metabolism
- clearance reduced by alkaline urine

Precautions: may worsen seizures, rare but serious cardiac events

Dosing:
- IR: 5mg QD -> 20mg QD
- ER: 7mg QD -> 28mg QD

ADE: hypertension, hypotension, aggressive behavior, anxiety/depression, confusion, dizziness, hallucinations, head ache, pain, weight gain, constipation, N/V/D, urinary incontinence, influenza infection, back pain, cough, dyspnea

Question 11

Nemzaric (Memantine ER + Donepezil)

Answer 11

take in evening with or without food
must be stable on donepezil 10mg before starting

Question 12

AChE-I side effects: SLUDGE

Answer 12

Sialorrhea (drooling)
Lacrimation
Urination
Defecation
GI
Emesis

Also:
- HA, insomnia, vivid dreams
- bradycardia syncope, heart block, hypotension
- anorexia, weight loss

Question 13

Drugs that may worsen cognitive decline

Answer 13

Anticholinergic Agents
□ Diphenhydramine
□ Oxybutynin
□ Codeine
□ Meclizine
□ Scopolamine
□ Promethazine
□ Prochlorperazine
□ Benztropine
□ Trihexyphenidyl
□ Belladonna
□ Clindinium
□ Hyoscyamine
□ Cyclobenzaprine
□ Amitriptyline
□ Chlorpromazine
□ Thioridazine
Clozapine