Dementia

Question 1

Dementia is defined by problems with what?

Answer 1

Memory loss, problems with reasoning/communication, change in personality,
and a reduced ability to carry out daily activities such as washing or dressing

Question 2

Antipsychotics can increase the risk of what in elderly patients? when used in dementia???? They should only be given to who? And experiencing what

Answer 2

 Increased risk of stroke when used in elderly with dementia
 Should only be used if patient at risk of harming themselves/others, or
experiencing agitation, hallucinations or delusions causing them severe
distress

Question 3

Dementia what is it?? And what does it warrant???…( and what is the most common type + the other common types of dementia??)

Answer 3

• Dementia is a clinical syndrome - range of cognitive and behavioural symptoms - memory loss,problems with reasoning and communication,change in personality and reduced ability to carry out daily activities
  
  • Alzheimer’s disease is the most common type of dementia other types: Vascular dementia(cerebra vascular disease),dementia with levy bodies,mixed dementia,frontotemporal dementia

Question 4

Aim of treatment OF DEMENTIA

Answer 4

• Aim of treatment= promote independence, maintain function and manage symptoms of dementia

Question 5

Non Drug treatment- building on cognitive(mild to moderate)

Answer 5

Patients with all types of mild to moderate dementia with cognitive symptoms should be given opportunity to participate in cognitive simulation programme, group reminiscence therapy, cognitive rehab,functional ability support

Question 6

What do acetylcholine esterase inhibitors do?
Which drugs have antimuscarinic effect?
Which drugs are urinary antispasmodics?
Examples of anti histamines?

Answer 6

• Acetylcholene esterase inhibitors - inhibiting the protein that breaks it down
  • Drugs with antimuscarinic effects include some anti depressants eg. Amitriptyline,paroxetine
  • Anti histamines - eg.Chlorphenamine, promethazine,
  • Uriniary antispasmodics eg, Solifenacin succinct, tolterodine tartate

Question 7

Mild to moderate: which Acetylcholinesterase inhibitors are used in dementia??? And what are some side effects? DRG

Answer 7

Acetylcholinesterase inhibitors
- Donzepezil - neuroleptic malignant syndrome
- Rivastigmine - Gastrointestinal side effects - reduced transdermal formulation
- Galantamine - stevens- Johnson syndrome

Question 8

Moderate, what is aggravation treated with? We can use it in patients with dementia but not?

Answer 8

meantime
Aggravation treated with antipsychotics
Can use antipsychotic in patients with dementia but not with patients with Parkinson’s

Question 9

Side effects of memantine - what pathway does it work what is this pathway associated with? Dumbbels

Answer 9

works on the parasympathetic pathways (REST,DIGEST AND SECRETE)
- Diarrhoea
- Urinary incontience
- Muscle weakness
- Bradycardia
- Bronchospasms
- Emetics
- Lacrimation
- Salivation

Question 10

Alzheimer’s:
How is it treated? Mild to moderate? when is memantine introduced?
What happens to patients with other side effects? What do we manage?

Answer 10

Alzheimer’s:
Mild to moderate patients - Monotherapy with donepezil hydrochloride,galantamine or rivastigmine(acetyl choline inhibitor).If acetylcholineesterase inhibitors not tolerated or contraindicated - memantine hydrochloride - alternative

Memantine hydrochloride- sever Alzheimer’s

Agitation,aggression,distress and psychosis - offer patients psychosocial and environmental interventions

Manage depression,anxiety and sleep disturbances