dementia Flashcards
most common type of dementia
AD
what is it
progressive clinical syndrome characterised by a range of cognitive and behavioural symptoms
state some cognitive and behavioural symptoms (4)
Memory loss
Problems with reasoning and communication
Change in personality
Reduced ability to carry out daily activities e.g. washing and dressing
AD is the most common type. Name 4 other common types.
Vascular dementia (due to cerebrovascular disease)
Dementia with Lewy bodies
Mixed dementia
Frontotemporal dementia
vascular dementia occurs due to
cerebrovascular disease
6 RF for dementia
Ageing
Mild cognitive impairment
Genetics
PD
Cerebrovascular disease
CVD
4 modifiable risk factors for dementia
Smoking
DM
Lack of physical activity
Obesity
Does AD occur on its own
often co-exits with other forms of dementia e.g. vascular dementia
what is a warning sign of dementia?
onset of depression later on in life
a patient who has loss of recent memory first, as well as loss of episodic memory (e.g. memory loss for revent events, repeated questioning, difficulty learning new info) is likely to have which type of dementia?
AD
for this type of dementia, memory impairment may not be apparent in early stages
dementia with lewy bodies
a pt who has focals (e.g. visual field defects) and a stepwise increase in severity of symptoms such as gait and attention problems and changes in personality is likely to have
vascular dementia
a patient who has recurrent visual hallunications, REM sleep behaviour disorder and one or more symptoms of parkinsonism (e.g. bradykineisa, rest tremor, ridigity) or core clinical features of fluctuating cognition is likely to have
dementia with Lewy bodies
for this type of dementia, personality change and behavioural disturbance (e.g. apathy or social/sexual disinhibition) may develop insidiously, while other cogntivie functions such as memory and perception may be relatively preserved
frontotemporal dementia
abrupt change or stepwise decline could point to ….
vascular cause
insidious onset with slow progressive course points to…
degenerative process
why is medical history important in pt suspected of having dementia
increased cholinergic burden = increased cognitive impairment e.g. from BZDPNs, anticholinergics, opoids
consider minimising use of meds associated with increased anticholinergic burden, and if possible look for alternatives
non drug treatment for all types of mild to moderate dementia presenting with cognitive symptoms
give pt the oppurtunity to participate in structures group cognitive stimulation programe
also consider group reminiscence therapy (life stories to improve phsychological well being) and cognitive rehab or occupational therapy to support daily functional ability
drugs with antimuscarinic effects increase cognitive impairment. give some examples of 4 classes and examples of drugs for each
Antidepressants e.g. amitriptyline, paroxetine
Antihistamines e.g. chlorphenamine, promethazine
Antipsychotics e.g. olanzapine, quetiapine
Urinary antispasmodic e.g. solifenacin, tolterodine
Treatment of AD in newly diagnosed pt - who can start it?
only initiate drug treatment under advice of specialist clinican experienced in management of AD
AD mild to moderate 1st line + alternative 2nd line
monotherapy with donepezil, galantamine or rivastigmine (ACh-esterase inhibitors)
if these are not tolerated or CI, an alternative in MODERATE AD is memantine
treatment of severe AD
memantine
In patients already recieving an Achesterase inhibitor (donep, rivast, galant) and they develop moderatre or severe disease, what can you do
consider adding memantine
this can be initiated in primary care w/o advice from specialist
In patients with moderate AD, what effect can discontinuation of Achesterase inhibitors have
Can cause a substantial worsening in cognitive function
Do not discontinue treatment based on disease severity alone