Dementia

Question 1

What are the risk factors for Dementia?

Answer 1

1. Age
2. Genetics
3. CVD
4. Parkinson’s
5. Lifestyle e.g. smoking, drinking, lack of physical activity, obesity

Question 2

What are the different types of Dementia?

Answer 2

1. Alzheimer’s
2. Vascular
3. Levy bodies
4. Mixed (a mixture of two types of dementia like Alzheimer’s n vascular)
5. Frontotemporal

Question 3

What is the most common type of Dementia?

Answer 3

Alzheimer’s

Question 4

What is Vascular, levy bodies and frontotemporal dementia?

Answer 4

Vascular - a reduced blood flow to the brain (can be due to cerebrovascular disease like stroke)

Lewy bodies - clumps of protein which form in the brain and affect memory, movement, thinking etc.

Fronto - degeneration of frontal and temporal lobes in the brain.

Question 5

What are the symptoms of dementia?

Answer 5

1. Cognitive dysfunction:
   - memory loss
   - concentration loss
   - communication and reasoning problems
2. Behavioural symptoms
   - aggression
   - distress
   - agitation
   - psychosis
3. Difficulties with activities of daily living

Question 6

What drugs are used in Alzheimer’s dementia?

Answer 6

For mild - moderate Alzhimers disease

Acetylcholinesterase inhibitors are 1st line options (monotherapy):
1. Donepezil - initially 5mg OD for 1 month, increase to 10mg daily if necessary, taken to bed time.
2. Galantamine
3. Rivastigmine

For moderate to severe Alzheimer’s disease (or if above is contraindicated):

Glutamate receptor antagonist
- Memantine = max 20mg daily, (can be used as an alternative or add on to AChE inhibitors)

Question 7

What is the dose for memantine?

Answer 7

Initially 5mg OD, then increased in steps of 5mg every week.
Usual maintenance is 20mg daily; max is 20mg daily.

Question 8

What drugs are used in other dementia?

Answer 8

Mild - severe with lewy bodies:
1. Donepezil or Rivastigmine as 1st line
2. Galantamine if above is not tolerated
3. Memantine if above is contraindicated

Vascular dementia:
1. AChE or Memantine
(only used in patients with suspected co-morbid Alzheimer’s disease, Parkinson’s or Lewy bodies

Frontotemporal dementia:
DO NOT USE AChE OR MEMANTINE!
- antidepressants or antipsychotics can help reduce some symptoms

Question 9

What can happen when these dementia drugs are discontinued?

Answer 9

In patients with moderate Alzheimer’s disease, stopping the drug can cause a worsening in cognitive function.

Question 10

What can Anticholinergic drugs do to people with dementia?
What are examples this?

Answer 10

They can increase cognitive impairment and therefore their use should be minimised.

These includes:
1. Antidepressants
2. Antihistamines
3. Antipsychotics
4. Urinary antispasmodics e.g tolterodine

Question 11

What are the MHRA warnings for dementia patients?

Answer 11

For elderly patients WITH dementia, avoid use antipsychotics due to increased risk of stroke.

If use is very necessary, assess previous history of stroke, TIA, etc, and balance risk n benefits.
If unavoidable, use at lowest effective dose and for shortest time possible.

Review every 6 weeks however.

Those with lewy bodies or parkinson’s disease dementia, antipsychotic drugs can worsen motor symptoms.

Question 12

Which dementia patients can receive antipsychotics?

Answer 12

Those with high risk of harming themselves or others, or have hallucinations or delusions that cause severe distress.