Dementia Flashcards
mild vs severe dementia symptoms
mild: depression, anxiety, irritability, apathy
severe: agitation, aggression, vocalizations, delusions, hallucinations, disinhibition
DICE approach to dementia
describe, investigate, create, evaluate
which antipsychotic to use if needed in dementia
quetiapine > risperidone > haloperidol
non-pharm strategies for caregivers
scheduled toileting, positive reinforcement to increase independence, avoid debates, maintain a calm demeanor, *use support groups
non-pharm strategies for patients
music during meals and bathing, light exercise/walking, stimulate family presence with video, pet therapy, speak at patients comprehension level, bright lights and white noise
psychotic symptoms
delusions, hallucinations
seen in about 20% of Alzheimers patients
preferred agents for treating dementia related psychosis
aripiprazole, brexpiprazole, olanzapine, quetiapine, risperidone
treatment for psychosis caused by Parkinson’s or Lewy body dementia
quetiapine, olanzapine, pimavanserin
antidepressants NOT recommended to treat depression in dementia
paroxetine, desipramine, nortriptyline (all have anticholinergic effects)
other medications to use to treat depression in dementia
mirtazapine (useful w/ insomnia and weight loss) and trazodone (when sedation is desirable)
difference between apathy and depression
apathy lacks depressive mood, guilt, and hopelessness
apathy treatment
methylphenidate, dextroamphetamine, modafinil
manic-like behavior treatment in dementia
carbamazepine, lamotrigine, lithium, divalproex (sprinkle)
agitation or aggression non-pharm treatment
exclude underlying physical discomfort, identify triggers if less than once per week, behavior modification, NOT physical restraint
agitation due to psychosis treatment
aripiprazole, brexpiprazole, olanzapine, quetiapine, risperidone
agitation due to depression treatment
SSRI
agitation due to anxiety or mild to moderate irritability
buspirone or trazodone
agitation or aggression unresponsive to first line treatment
carbamazepine, divalproex, olanzapine
sexual aggression treatment in men
divalproex or 2nd gen antipsychotic (olanzapine, risperidone, aripiprazole)
estrogen or medroxyprogesterone
sundowning treatment
non-pharm: night lights, check ins
acute: trazodone, antipsychotics
long-term: trazodone, melatonin, antipsychotics
insomnia treatment
good sleep hygiene (caffeine, fluid intake, time in bed), trazodone and melatonin, BZDs for short term use only
