Dementia

Question 1

What medication is effective in managing cognitive and behavioral symptoms of LBD?

Answer 1

Acetylcholinesterase inhibitors such as rivastigmine, galantamine, and donepezil have been shown to be effective in managing the cognitive and behavioral symptoms.

Question 2

What Functional Assessment Staging (FAST) criteria score is needed to qualify of hospice?

Answer 2

7C – Exhibiting end-stage complications of dementia meet criteria for hospice.

Question 3

What should be considered when any patient with long-term malnutrition presents with altered mental status or ataxia?

Answer 3

Severe thiamine!

Wernicke encephalopathy develops after approximately 4–6 weeks of thiamine deficiency. If not recognized and treated early, it can become significantly disabling or even lethal.

Any patient suspected of having or being at risk of development of Wernicke encephalopathy should be started on thiamine as rapidly as possible (SOE=A).

A lower dosage of thiamine is needed for nonalcoholic patients than for patients with alcoholism because alcoholism impairs thiamine absorption.

Question 4

What disease was excluded from the SPRINT trial?

Answer 4

DIABETES, Patients with dementia or frailty (weight loss, life expectancy <3 years, and orthostasis) and nursing home residents were systematically excluded because of the assumption that they would not benefit.

Question 5

What was the MoCA score that showed benefit from lowering BP in the SPRINT follow-up study?

Answer 5

scores ≥18 were associated with improved longevity; there was a trend toward increased mortality among patients with MoCA score <18.