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Dementia Flashcards

1
Q

DSM - 5 Criteria for Dementia

A
  1. Major: significant cognitive decline and substantial impairment in cognitive function
  2. Minor: modest cognitive decline and modest impairment in cognitive function
  3. Interferes with independent in everyday activities (ADLs affected)
  4. Rule out delirium
  5. Not explained by another mental disorder —> rule out other psychiatric conditions
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2
Q

Stage of AD (Scoring of Test)

A

MMSE (30):
- Severe < 10
- Moderate 10-19
- Mild 20-24

MOCA (25)
- Severe < 10
- Moderate 10-17
- Mild 18 - 25

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3
Q

Explain AD (Pathological, Onset and Features in Early Stage)

A

Brain atrophy - beta amyloid and neurofibrilatory tangles containing phosphorylated tau

Onset is usually slow and gradual over months and years

Hx: STM, episodic memory impairment with subtle cognitive deficits (anomia - cannot use words etc, visualspatial)

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4
Q

Explain LBD (Pathological, Onset and Features in Early Stage)

A

Brain atrophy with Lewy body inclusions (seen in PD)

Onset: slow and gradual but FLUCTUATIONS in alertness and cognition

Hx: rapid eye movement behaviour for years preceding cognitive impairment, visual and other hallucinations

Present with Parkinsonism, bradykinesia, rigidity, stooped posture, slow and shuffling gait

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5
Q

Explain Vascular Dementia (Pathological, Onset and Features in Early Stage)

A

Usually infarcts are observed (ischemic lesions)

Onset: temporal relation between vascular event and onset (usually within minutes or days)

Hx: vascular risk factors, stroke, focal neurological deficits (unilateral weakness, hyper reflexes, babinski sign)

Neuro image: white matter changes on MRI, infarcts

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6
Q

Explain Frontal Temporal Dementia (Pathological, Onset and Features in Early Stage)

A

Focal brain atrophy affecting frontal and or anterior temporal lobes

Onset: similar to AD (slow and gradual onset over months and years)

Hx: marker change in behaviour and personality

Language problems, impaired fluency in speech, disinhibition and inappropriate behaviours

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7
Q

Risk Factors for Dementia (Non modifiable and Modifiable)

A

Non modi
- Age
- Female
- Black, Hispanic
- Gene: APOE4 for AD

Modi:
- HTN, DM, Depression
- Binge drinking, smoking, lack of exercise
- Hearing loss
- Obesity

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8
Q

Non Pharmacological for Dementia

A
  • Cognitively stimulating activities
  • Physical exercise
  • Social interaction
  • Healthy diet (Mediterranean)
  • Sleep hygiene
  • Personal Hygiene
  • Home and Outside safety
  • Medical and Advance care directives
  • Long term care plan
  • Financial planning
  • Effective communication with visual aids
  • Psychological health - music, meaningful activities
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9
Q

AD Drugs: Acetylcholinesterase Inhibitors (Provide Name, Dose, MOA, Side Effect, Considerations, CI, Precaution etc)

A

Acronym: DRG

Slow titration over 4-8 wks

MOA: inhibit acetylcholinesterase and increase acetylcholine

S/E: nausea, vomiting, insomnia, vivid dreams, loose stool, loss of appetite

Caution: PUD, seizures, urinary tract obstructions

CI: bradycardia

Donepezil (all stage): 5mg OD for q6 weeks to 10mg OD (max: 23mg OD)

Rivastigmine (Mild - Moderate): 1.5mg BD for 2 wks—> 3mg BD for 2 wks —> 4.5mg BD for 2 wks —> 6mg BD

Galantamine (Mild - Moderate):
- XR: 8mg OD for 4 wks —> 16mg OD for 4 wks (target 16-24mg OD)
- IR: 4mg BD for 4 wks —> increase to 12mg BD if needed (target: 8-12mg OD)

Excessive acetylcholine —> muscarinic (bradycardia, salivation, increased GI motility, bronchoconstriction)

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10
Q

AD Drugs: Memantine (Dose, MOA, Side Effect, Considerations, Precautions etc)

A

Moderate to severe AD

MOA: NMDA receptor antagonist that blocks effect of elevated tonic effects of glutamate

Dose: 5mg OD —> then 5mg increment to 20mg OD

S/E: headache, constipation, confusion and dizziness

Caution: CVD, Seizures, severe renal and hepatic impairment

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11
Q

Mgmt of Lewy Body Dementia

A
  1. Donepezil or Rivastigmine
  2. Galantamine only if D or R not tolerated
  3. Memantine only if DRG not tolerated
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12
Q

When to avoid Acetylcholinesterase Inhibitor or Memantine

A

AVOID
- frontotemporal dementia
- cognitive impairment due to MS

Consider
- Vascular dementia
- Suspected co-morbid AD, PDD or DLB

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13
Q

BPSD Mgmt: Agitation and Aggression

A

Cause: underlying unmet needs

Soltn: environmental or mgmt modification to resolve these issues (calming and positive intervention)
- Music, Touch therapy
- Hand massage

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14
Q

BPSD Mgmt: Depression

A
  1. Exercise, social connection
  2. CBT
  3. Severe depression —> psychiatrist (need medications)
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15
Q

BPSD Mgmt: Anxiety

A

Cause: changes are fearful to them

  1. Eliminate trigger
  2. Maintain structure and routine
  3. Assess sensory overstimulation
  4. Music and CBT
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16
Q

BPSD Mgmt: Apathy (withdrawal from world - more for vascular and DLB)

A
  1. Reading to the person and encourage them to ask question
  2. Small group and individual activities
  3. Music, exercise, multi sensory stimulation
17
Q

BPSD Mgmt: Psychotic symptoms (delusion, hallucination)

A
  1. Confirm claims are not occurring
  2. Use memory aids
  3. Distractions
18
Q

BPSD Mgmt: Wandering

A
  1. Safe wandering: GPS tracker, secured space to roam
  2. Determine cause of wandering (looking for person, try to return home)
19
Q

BPSD Mgmt: Nocturnal disruptions (sleep disturbance)

A
  1. Assess underlying cause esp thirst or hunger
  2. Restrict caffeine in evening
  3. Limit fluid intake
  4. Minimise light and noise intrusion
  5. Adequate stimulating activities in daytime
20
Q

Pharmacologicals for BPSD (What Meds, When to Initiate)

A

Initiate: Only if harming themselves or severely distress to patients or others

SSRI: citalopram reduce agitation in patients with AD and may improve delusion but caution with QTC prolonging effect

Antipsychotic: quetiapine for PDD, risperidone or haloperidol etc
-assess every 6 weeks if needed and stop if not helping or not necessary

AVOID TCAs

21
Q

Monitoring Parameters for Treatment Improvement

A
  • Caregiver feedback on improvement on day to day activities
  • routine cognitive test (MOCA or MMSE)

CNS (2 decks)

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