Dementia Flashcards
What type of memory does dementia affect?
Declarative episodic memory (memroy of a particular time and place)
Besides memory, what are the other common manifestations of dementia?
- Decreased problem solving skills
- Worsened mood
Classification of severity of depression according to MMSE
- Mild: 19 - 26
- Moderate: 10 - 18
- Severe < 10
State the drug class used as first line therapy for dementia
Cholinesterase inhibitors
Describe the dose and titration of oral donepezil in dementiia
Start 2.5 - 5 mg OD, increase to 10 mg OD after 4-8w
Describe the dose and titration of rivastigmine PATCH in dementia
Start with 4.6 mg/24h patch OD, titrate up to 9.5 mg/24h patch after 4 weeks
Describe the dose and titration of rivastigmine CAPSULES in dementia
1.5 mg BD after MEALS, titrate 1.5mg/week up to 6 mg BD
Describe the dose and titration of galantamine prolonged-release in dementia
Initial 8 mg OD, titrate by 8 mg q4w until 16 - 24 mg OD
What is the place in therapy for NMDA antagonists?
Used in COMBINATION with cholinesterase inhibitors in ADVANCED PD
OR
As an alternative if cholinesterase inhibitors are contraindicated
Describe the dose and titration of memantine in dementia?
5 mg OD, titrate 5mg q1-2w up to 10 mg BD or 20 mg OM
Significant side effect of memantine
CNS effects such as dizziness, headache, confusion
Cholinesterase inhibitor(s) that require renal dosing adjustments
Galantamine
(Donepezil no need dose adjustment for both renal and hepatic insufficiency)
Cholinesterase inhibitor(s) that require caution in patients with liver impairment
Galantamine and Rivastigmine
(Donepezil no need dose adjustment for both renal and hepatic insufficiency)
Common side effects of cholinesterase inhibitors and their management
- Nausea and diarrhea: resolves over time. Take with food. Can switch to donepezil if necessary
- Bradycardia and hypotension: Discontinue if symptoms manifest
- Vivid dreams and insomnia (especially donepezil): take in morning instead
