Dementia Flashcards
How long from onset of sx is enough to be considered as dementia?
≥6m
Main pathophysiology of dementia?
- senile plaques
- neurofibrillary tangles
- brain atrophy (decrease cholinergic)
Symptoms of dementia?
Areas affected: cognitive, psychological, behavioural, sleep, physical
- memory loss
- word-finding difficulties & loss of language
- delusion, depression, aggression, hallucinations
- wandering
- altered sleep wake cycle
- Parkinsonism
Mini Mental State Examination scale?
- mild
- moderate
- severe
- mild: 20-24/30
- moderate: 10-19/30
- severe: <10/30
Goals of therapy for dementia?
- slow progression
- delay the need to institutionalisation
- improve QOL of pt & caregiver
Nonpharm for dementia?
- exercise, diet, sleep, social interactions
- psychological (e.g. participate in personally meaningful activities)
- cognitively stimulating activities
Treatment options for Alzheimer’s dementia?
- anticholinesterase inhibitors (AI): donepezil, rivastigmine, galantamine
- non-competitive NMDA receptor antagonist: memantine
At what stage of Alzheimer’s dementia can meds be used?
- donepezil: all stages
- rivastigmine: mild-moderate a/w parkinson disease
- galantamine: mild-moderate
- memantine: moderate-severe
MOA of AI?
inhibit acetylcholinesterase enzyme -> increase acetylcholine at synaptic cleft for cholinergic neurotransmission
SE of AI?
- N/V/D (cholinergic hyper activation), loss of appetite, increase frequency of bowel movements, increase gastric juice secretion
- vivid dreams, insomnia
- muscle cramp
- bradycardia
AI CI?
- bradycardia
When should AI be used with caution for dementia?
- PUD
- resp disease
- seizure disorder
- urinary tract obstruction
Dose of donepezil?
PO 5mg OD (6w) -> 10mg OD (max 23mg OD)
Dose of rivastigmine?
Tablet: PO 1.5mg BD (2w) -> 3mg BD (2w) -> 4.5mg BD (2w) -> 6mg BD (max)
Patch: 4.6mg/24h (4w) -> 9.5mg/24h (4w) -> 13.3mg/24h (max)
Dose of galantamine?
PO extended: 8mg OD (4w) -> 16mg OD (4w) -> 24mg OD (max)
PO immediate: 4mg BD (4w) -> 8mg BD (4w) -> 12mg BD (max)
Does galantamine or rivastigmine have a longer half life?
Galantamine
How are galantamine and rivastigmine metabolised?
- galantamine: liver
- rivastigmine: renal
Dose of memantine?
PO extended: 7mg OD (1w) -> 14mg OD (1w) -> 21mg OD (1w) -> 28mg OD (max)
PO immediate: 5mg OD (1w) -> 5mg BD (1w) -> 5mg OM & 10mg ON (1w) -> 10mg BD (max)
SE of memantine?
- HA
- confusion
- dizzy
- hallucination
- constipation
When should memantine be used in caution in pts with dementia?
- CVD
- seizure disorder
- severe hepatic / renal impairment
For behavioural & psychological sx of dementia, what is the first line of treatment?
Non pharm
What are some behavioural & psychological sx of dementia?
- agitation & aggression
- depression
- anxiety
- apathy
- psychotic sx (hallucinations, delusion)
- wandering
- nocturnal disruption
How long should meds be used for BPSD?
3m, then slowly withdraw if sx improve
Treatment options for vascular dementia?
- AI
- memantine
Treatment options for dementia with Lewy bodies?
- AI
- memantine
Treatment options for frontotemporal dementia?
- SSRIs
- memantine
- AI
When should pt come back for follow-up when on cognitive enhancers?
- 3-6m after starting therapy
- Q1y after that
