dementia

Question 1

types of dementia

Answer 1

vascular, lewy body, frontotemporal, alzheimers

Question 2

MMSE score

Answer 2

20-24 mild
10-19 mod
<10 sev

Question 3

lab tests to evaluate dementia

Answer 3

thyroid and b12 can include metabolic, autoimmune, infectious

Question 4

patho of alzheimer’s disease

Answer 4

neurofibrillary tangles, amyloid plaques

Question 5

AchEi moa

Answer 5

inhibit acetylcholinesterase enzyme increase acetylcholine abundance at synaptic cleft for cholinergic neurotransmission

Question 6

dose of AchEi

Answer 6

titrate over 4-8wks

donepezil 2.5-5mg OD max 10mg OD
rivastigmine 4.6mg/24h - 9.5mg/24h
galantamine 4mg BD max 16-24mg/d (crcl <60 mac 16mg/d, <9 avoid)

SE: caution seizures, GI, anorexia, bradycardia , may worsen BPH symptoms

Question 7

AchEi DDI

Answer 7

cyp3a4 inducers -> carbamazepine, phenytoin
inhibitors -> ketoconazole, clarithromycin
2d6 inducers -> carbamazepine, phenobarbitone

Question 8

NMDA antagonist moa

Answer 8

bind to NMDA receptor and reduce calcium influx and stimulation

Question 9

dose of memantine

Answer 9

5mg OD increase 5mg q1-2wks max 10mg BD
crcl <30; max 5mg BD

SE: drowsiness, dizziness, headache, fatigue, hallucination, agitation

Question 10

BPSD

Answer 10

non cogntive and non neurological symptoms such as agitation, aggression, psychosis, depression, apathy

Question 11

what consist of BPSD

Answer 11

aggression and agitation
depression
anxiety
apathy
psychotic symptoms -> delusion/hallucination
wandering
nocturnal disturbances

Question 12

delirium causes

Answer 12

Drugs: opioids, TCA, antipsychotics,antiepileptics, antiemetics, benzodiazepines, muscle relaxants
Electrolytes
Low o2 states
Restraints/retention
Ictal state: seizure
Under hydration
Metabolic: hypoglycemia, hyperglyc, vitb12/folate deficiency

Question 13

BPSD gist

Answer 13

psychological effects
- delusions/hallucinations -> antipsychotics (haloperidol is not first line)
anxiety -> SSRI or SNRI
depression -> SSRI
apathy -> bupropion

behavioural no drugs

Question 14

risk of antipsychotics

Answer 14

1st gen antipsychotics higher risk of mortality due to MI and stroke

risperidone and olanzapine higher risk than quetiapine

Question 15

EPSE

Answer 15

akathisia : restlessness
pseudoparkinsonism: tremors, bradykinesia
tardive dyskinesia: orofacial movement (worsens with anticholinergic)
dystonia: painful muscle spasms

-> treatment with propanolol 10mg BD PRN (akathisia), clonazepam PRN (A,T,D)
benzhexol (pseudoparkinsonism)