Dementia Flashcards
Features of common dementia Syndromes
Alzheimer
- Insidious onset progressing to profound memory impairment, dysphasia, dyspraxia, personality change
Frontal
- Personality change, Social disinhibition, Apathetic and withdrawn
- Lewy Body - VIsual hallucinations, spontaneous motor parkinsonism, fluctuating mental state in absence of delerium
- Vascular - Starts suddenly. Focal neurological signs with evidence of CVA
Alcohol associated - Deficits in new learning and in frontal function
Pharmacological therapies for Alzheimers Disease
1 Acetylcholinesterase inhibitors
- E.g. Donepezil 5mg PO OD, Galantamine 8mg PO OD, Rivastigmine 1.5mg PO BD
- Decrease breakdown of acetylcholine, reduce deficiency in cholinergic neurotransmitter activity
- MMSE must be > 10
- AE - Nausea, vomiting, diarrhoea, anorexia, depression, headache, muscle cramps
- Toxicity - Dizziness, drowsiness, bradycardia, syncope, salivation, convulsions
2 NMDA-Receptor antagonist
- E.g. Memantine 5mg PO OD
reduces glutamate-induced neuronal degradation in Alzheimers
- Recommended 2nd line if unable to tolerate AChI.
- MMSE 10-14
- SE - GI Upset, confusion, dizziness, headaches, agitation
- Contra - Seizures
Management of Vascular Dementia
- Appropriate antithrombotic therapy according to stroke subtype.
- Progressive decline not attributable to Stroke? Commence donepezil 5mg PO OD
Non-pharmacological management of increased aggression in context of dementia
- Identify and reduce triggers of aggression
- Provide calm, low-stimulating environment
- Simplify instructions when conversing
- Offer positive reinforcement for good behaviour
- Provide familiar environment (Photos of family, consistent staff / routine)
- Time orientation aids
- Integrated regular leisure activities (Arts, crafts, gardening)
- Anxiety management (Reassurance from staff and family)
Risk factors for developing dementia
- Sedentary Lifestyle
- Excessive alcohol intake
- Smoking
- History of head injury
- Low level of social engagement
- Family history of dementia
- History of depressed mood
- Exposure to air pollution.