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3153 Finals > Dementia > Flashcards

Dementia Flashcards

1
Q

Describe the diagnosis of dementia as outlined by DSM-5 criteria. (4)

A

(A) Significant cognitive decline from prior levels in 1 or more domains
- Complex attention
- Executive function
- Learning and memory
- Language
- Perceptual motor or social cognition

(B) Cognitive deficits interfere with independence in carrying out daily activities

(C) Cognitive deficits do NOT occur exclusively in context of delirium

(D) Cognitive deficits NOT better explained by another mental disorder

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2
Q

What are the hallmark symptoms of dementia (initial vs late stage)?

A

Initial/early stages: Cognitive sx
- Short-term memory loss
- Word-finding difficulties or loss of word meaning

Late stages: Behavioral and psychological sx
- Loss of motor skills and language
- Long-term memory loss
- Disorientation, wandering

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3
Q

List the modifiable risk factors for dementia. (8)

A
  • Hypertension
  • DM
  • Binge drinking
  • Smoking
  • Obesity
  • Limited physical activity
  • Hearing loss
  • Depression
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4
Q

List the non-modifiable risk factors for dementia.

A
  • Age > 65
  • Female
  • Black or Hispanic
  • Genetics (APOE4 gene; apolipoprotein E)
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5
Q

Describe the 2 key features in the pathophysiology of dementia.

A

1) Senile plaques
- Improper degradation of amyloid precursor protein (APP)
- AB monomers formed which stick tgt to form amyloid plaques
- Plaques interfere with neuron signaling via extracellular deposition, damage neurons via triggering inflammation and lead to angiopathy of cerebral BV via deposition around blood vessels

2) Neurofibrillary tangles
- Beta-amyloid plaques cause abnormal downstream phosphorylation of TAU and clumping, which destabilise microtubule tracks in cells
- Interfere with normal cell signaling, leading to neuronal cell apoptosis

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6
Q

Describe the place in therapy of acetylcholinesterase inhibitors (AChEi) in dementia treatment.

A
  • For newly diagnosed pts of mild severity to preserve cognitive function for as long as possible
  • Efficacy is not very significant
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7
Q

Describe the dosing regimen of AChEi for dementia and state how ADRs are managed.

A
  • Slow-titration over 4-8 weeks to minimise adverse effects
  • If ADRs do occur, lower dosage temporarily and re-escalate more slowly. Monitor for recurrence of ADRs
  • Alternatively, discontinue drug and start on a different AChEi.
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8
Q

List the 2 commonly used AChEi for dementia.

A

1) Donepezil (oral tablets)
2) Rivastigmine (oral capsules or transdermal patches)

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9
Q

Describe the place in therapy of NMDA receptor antagonists in dementia treatment.

A
  • For newly diagnosed pts with moderate-to-severe dementia
  • For patients whom are intolerant or received inadequate response to AChEi
  • May be used as monotherapy or in combination with AChEi
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10
Q

What are common adverse effects of AChEi?

A
  • Nausea/vomiting
  • Loss of appetite
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11
Q

In what group of patients are AChEi contraindicated and to be used in caution?

A
  • Bradycardia

Caution use in
- Seizures
- PUD
- Respiratory disease
- Urinary tract obstruction

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12
Q

What are the common adverse effects of NMDA receptor antagonists?

A
  • Headache
  • Constipation
  • Confusion
  • Dizziness
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13
Q

In what group(s) of patients should use of NMDA-RA be cautioned?

A
  • CVD
  • Severe hepatic impairment
  • Seizures
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14
Q

State the commonly used NMDA-RA in dementia.

A

Memantine

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15
Q

List the behavioral and psychological symptoms of dementia (7)

A

1) Agitation and aggression
2) Depression
3) Anxiety
4) Apathy
5) Psychosis/psychotic sx
6) Wandering
7) Nocturnal disruptions

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16
Q

Describe how aggression and agitation is managed in dementia.

A
  • Sx may be due to underlying depression or unmet needs
  • Make environmental or management modifications
  • Calming and positive experiences (music/touch therapy, hand massage etc)
17
Q

Describe how depression is managed in dementia.

A
  • Exercise, social connection and engagement in fun activities
  • CBT
  • SSRI if cannot be managed by non-pharmacologic means
  • Clinician input in cases of severe depression
18
Q

Describe how anxiety is managed in dementia.

A
  • Identify and eliminate trigger(s)
  • Maintain structure and routine
  • Reduce the need for stressful decision-making
  • Music and CBT
19
Q

Describe how psychotic sx are managed in dementia.

A
  • Confirm/reassure that patient’s claims are not occurring
  • Memory aids to cue patient to reality
  • Distractions
  • Antipsychotic only used when patient is at high risk of harming him/herself or others or in severe distress
20
Q

Describe how wandering is managed in dementia.

A
  • Allow for wandering to occur under supervision/use of devices to safely pinpoint location of patient
  • Determine if there is a purpose in patient’s wandering
21
Q

Describe how nocturnal disruptions are managed in dementia.

A
  • Assess underlying cause (e.g. thirst, hunger)
  • Restrict caffeine in the evening, limit fluid intake before bedtime
  • Establish a night routine
  • Minimise light and noise intrusions
  • Ensure sufficient/adequate stimulation from day activities
22
Q

Describe the general role of pharmacologics in management of BPSD incl indication for use and duration of use.

A
  • Limited role in management; largely prescribed for target symptoms or behaviors
  • Only considered once non-pharmacological interventions are tried and reversible causes excluded
  • Always use in combi with non-pharmacological interventions
  • Routinely withdrawn after 3 months of sx improvement, unless indicated for comorbid psychiatric disorder (e.g. bipolar/depression)
  • Re-started at lowest effective dose, if sx return
23
Q

Describe the role of SSRIs in management of BPSD

A
  • For depression and anxiety
  • Citalopram can improve delusions and reduce agitation
24
Q

Describe the use of antipsychotics in management of BPSD

A
  • Only appropriate if aggression, agitation or psychotic sx are causing severe distress or risk of immediate harm
  • Used for max 6-12w (due to risk of cardiac arrest, pneumonia and stroke)
  • Unlikely to be effective for wandering, social withdrawal and inappropriate sexualised behavior
25
Q

List the MMSE scoring for mild, moderate and severe AD

A

The lower the score, the more severe the dementia

Scoring: (out of 30)
* Mild = 20-24
* Moderate = 10-19
* Severe = < 10

26
Q

State monitoring parameters for AD drugs

A

1) Caregiver feedback on improvement in day-to-day activities (improved ability to function at home)

2) Routine cognitive tests (e.g MMSE and Montreal Cognitive Assessment MoCA)

3) ADR

27
Q

State the respective scores corresponding to mild, moderate, severe cognitive impairment measured using MoCA

A

Scoring:
* Mild cognitive impairment: 18–25 points
* Moderate cognitive impairment: 10–17 points
* Severe cognitive impairment: < 10 points

28
Q

Describe caregiver support resources available (3)

A

1) AIC
2) Orange valley dementia care
3) Dementia Singapore

3153 Finals (8 decks)

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