Dementia Flashcards

Question

SE of memantine

Answer 1

headache, constipation, confusion, dizziness

Answer 2

N/V, loss of appetite, incr bowel freq, vivid dreams, insomnia patch: local skin rxn

Answer 3

- Reduce polypharmacy (take out drugs they dont need) - Review medications that may contribute to cognitive impairment eg. antihistamine -> anticholinergic effect - Assist caregiver on medication management issues e.g. simplify medication regimen, arrangement for medication refill (TDS -> BD? XR?, arrange delivery services) -Evaluate risk/benefit of existing medications (e.g. antithrombotics)

Answer 4

- Cognitively stimulating activities (eg, reading, games) - Physical exercise (eg, aerobic and anaerobic) - Social interactions with others (eg, family events) - Healthy diet such as the Mediterranean diet (eg, high in green leafy vegetables) - Adequate sleep (eg, uninterrupted sleep and with sufficient number of hours) - Proper personal hygiene (eg, regular bathing) - Safety, including inside the home (eg, using kitchen appliances) and outside (eg, driving) - Medical and advanced care directives (eg, designation of power of attorney) - Long-term health care planning (eg, for living arrangements in the late stage of dementia) - Financial planning (eg, for allocation of assets) - Effective communication (eg, for expressing needs and desires, such as with visual aids) - Psychological health (eg, participating in personally meaningful activities, such as playing music)

Answer 5

spectrum of non-cognitive and non-neurological symptoms of dementia, such as agitation, aggression, psychosis, depression and apathy.

Answer 6

Depression and anxiety while agitation and aggression more commonly occur later, especially as the person’s ability to communicate and influence their environment diminishes.

Answer 7

Verbal: complaining, moaning, angry statements Physical: resisting carers, restlessness, spitting, hitting

Answer 8

May be due to underlying depression, unmet needs, boredom, discomfort, perceived threat or violation of personal space. - Make environmental or management modifications to resolve these issues. - Non-specific calming and positive experience interventions may be beneficial such as music or touch therapy, e.g. hand massage, a mechanical pet or a twiddle muff (sleeve or glove with attached materials, buttons, etc, for sensory stimulation).

Answer 9

Sadness, pessimistic thoughts, withdrawal, inactivity, fatigue

Answer 10

Recommend exercise, social connection and engaging activities. Cognitive behavioural therapy (CBT) may be helpful in early stages. Severe depression: refer

Answer 11

Exaggerated response to separation from family, different settings or reduce capacity to make sense of env.

Answer 12

Focus on identifying and eliminating the trigger, rather than symptom control. Maintain structure and routine and reduce the need for stressful decision- making. Assess if sensory overstimulation may be contributing. Music and CBT have the greatest amount of evidence showing benefit.

Answer 13

Lack of initiative, motivation, reduce emotional response Reduced motivation can be a feature of depression, but a pure apathy syndrome can be distinguished from depression by the absence of sadness and other signs of psychological distress..

Answer 14

Reading to the person and encouraging them to ask questions, small group and individual activities, e.g. puzzles, games, sensory stories may all be helpful. Music, exercise, multi- sensory stimulation with touch, smell and sound, and spending time with pets can also be effective. The key is to provide enriched prompts and cues to overcome the apathy and generate positive behaviour.

Answer 15

Delusions, hallucinations In dementia, delusions are usually reflective of the underlying memory loss or changes in perception, e.g. accusation of theft of personal items, infidelity of a spouse or that family members are imposters, rather than delusions normally associated with mania or schizophrenia. Vivid visual hallucinations are common, particularly in Lewy Body dementia, but auditory hallucinations are less common

Answer 16

Confirm that the patient’s claims are not occurring, e.g. items are not being stolen. Use memory aids, e.g. photographs to cue the person to reality. Distraction can sometimes be effective.

Answer 17

Wandering may be circular, pacing between two points, random or direct to a location without diversion.

Answer 18

Wandering can have positive effects via exercise, e.g. improving sleep, mood and general health, and may prevent the person from feeling confined. Consider how to make wandering safe; supervised walks, secured space to roam, exercise equipment, GPS watch. Try to determine if there is a purpose to the wandering, e.g. trying to return home, looking for a person, escaping a perceived threat.

Answer 19

Sleep disturbance can occur secondary to depression, anxiety, agitation or pain and may cause other BPSD to be exacerbated at night, e.g. wandering. Occurs more frequently in people with Lewy Body dementia. Sundowning, i.e. increased agitation in the late afternoon, is also common.

Answer 20

Assess for underlying cause, including thirst or hunger. Restrict caffeine in the evening, limit fluid intake in the hours before bed, establish a night-time routine, minimise light and noise intrusion, ensure adequate stimulating activities during daytime

Answer 21

- Medicines with Anticholinergic actions - Systemic CS - Anticonvulsants - Medicines with sedative action - Anti parkinsonian meds

Answer 22

Delirium Untreated pain Constipation or urinary impairment Fatigue Hearing/visual impairment Depression Anxiety Dehydration

Answer 23

Unfamiliar env Separation Noise Crowding Loneliness

Answer 24

Pharmacological interventions have a limited role in the management of BPSD – consider adverse effects and indication for use

Answer 25

- Prescribed for target symptoms or behaviours for which there is evidence of effectiveness, i.e. they should not be used for other indications or to sedate patients who are difficult to manage - Only considered once potentially reversible causes have been excluded and non-pharmacological interventions have been trialled; unless there is an immediate risk to the patient or others, or the patient is very severely distressed - Always used in combination with non-pharmacological interventions

Answer 26

Routinely withdrawn, slowly, after three months of improved symptoms unless symptoms were severe or due to a co-morbid psychiatric disorder, e.g. bipolar disorder or major depression Re-started at the lowest effective dose, if symptoms return following a withdrawal, and schedule a further trial withdrawal in three to six months

Answer 27

SSRIs - citalopram Consider dose-dependent risk of increased QT prolongation and worsening cognition

Answer 28

No. anticholinergic effects may further disrupt cognition

Answer 29

Only appropriate for patients with BPSD if aggression, agitation or psychotic symptoms are causing severe distress or an immediate risk of harm to the patient or others or if the patient has a pre-existing, co-morbid mental illness where antipsychotics are indicated. Only modestly effective in managing BPSD, and the level of effectiveness varies between patients Unlikely to be beneficial for wandering, calling out, social withdrawal or inappropriate sexualised behaviour in people with dementia Less likely to be effective for intermittent but challenging behaviours that are closely related to clear environmental triggers (non-pharm rather than antipsychotic), e.g. aggression that only occurs during personal cares.

Answer 30

Increased risk of stroke, cardiovascular events and excess mortality over a relatively short time frame (esp older ppl w dementia).

Answer 31

Pneumonia Stroke Cardiac arrest