dementia

Question 1

risk factors of dementia (list 3)

Answer 1

female, APOE4 gene (AD), age, ethnicity (black, hispanic), htn, diabetes, binge drinking, smoking, limited physical activity, obesity, hearing loss, depression

Question 2

pathophysio of AD - senile plaques

Answer 2

clumps of amyloid precursor protein outside cell, due to specific dysregulation of metabolism. disrupts signalling, impairing brain function

Question 3

pathophysio of AD - neurofibrillary tangles

Answer 3

beta amyloid plaques causes activation of kinase and phosphorylation of tau.

Tau changes shape, stops supporting microtubules, clumps up with other tau proteins forming neurofibrillary tangles.

Question 4

Goals of Therapy of AD

Answer 4

Slow disease progression
Delay need for institutionalisation

Question 5

moa of anticholinesterase inhibitors

Answer 5

Inhibit acetylcholinesterase, promoting relative increase in ACh at synaptic cleft for cholinergic neurotransmission

Question 6

is galantamine or rivastigmine metabolised by liver

Answer 6

galantamine

Question 7

indication for anticholinesterase inhibitors

Answer 7

mild to moderate disease (donepezil for severe too)

Question 8

adverse effects of AI

Answer 8

1. Cholinergic hyperactivation
   NVD
   Loss of appetite
   Muscle cramp
   Increased gastric juice secretion
2. CNS
   Vivid dreams
   Insomnia

Question 9

ci of ai

Answer 9

Bradycardia

Question 10

precautions of AI

Answer 10

PUD,
respiratory disorders, seizures,
urinary tract obstruction

Question 11

half life of galantamine or rivastigmine longer?

Answer 11

galantamine

Question 12

which has transdermal patch

Answer 12

riva

Question 13

which can act on nicotinic receptors (g/r)

Answer 13

galant

Question 14

memantine moa

Answer 14

Non-competitive antagonist, blocks NMDA receptor mediated excitotoxicity

Question 15

memantine side effects

Answer 15

(mild)
Headache
Constipation
CNS (confusion, dizziness, hallucination)

Question 16

memantine precautions

Answer 16

CVS disease,
seizures,
severe hepatic/renal impairment

Question 17

bpsd: agitation
pharmacological?

Answer 17

ssri (citalopram)
antipsychs (only if immediate risk to patient or caregiver)

Question 18

bpsd: depression
pharmaco?

Answer 18

ssris, but can cause increased Qtc prolongation, worsening cognition

(Avoid TCA due to anticholinergic effects)

Question 19

nonpharm for apathy bpsd

Answer 19

Reading to the person
Provide enriched prompts and cues to overcome apathy
social interaction

Question 20

initial symptoms of dementia

Answer 20

depression, anxiety

Question 21

symptoms of dementia that appear later

Answer 21

agitation, aggression