Dementia Flashcards
what physiologic changes do you see in dementia brain?
inside neuron: neurofibulary tangles
outside: amyloid plaques
how long must cognitive dysfunction be present to diagnose dementia?
6 months
do hormones, NSAIDs or statins protect against dementia?
statins (not other cholesterol lowering meds)
what do you do for potential dementia patient
- serum: blood count, electrolytes, ca, renal function, liver enzymes, thyroid, B12, folic acid levels
- brain imaging: CT, MRI, SPECT, or PET to see amyloid plaque
- list of meds
what do you need to diagnose or rule out before giving pharmaceuticals?
DLB (dementia lewy body)
DLB
quick onset - faster than alzeimers
anatomical presence of lewy bodies
clinically more similar to parkinsons and alzeimers
dopamine loss =
acetylcholine loss =
dopamine loss = parkinsons
acetylcholine loss = alzeimers
acetylcholinesterase inhibitors
increased concentration of AChE, providing the brain with enhanced cholinergic transmission.
AChEI’s occur naturally in:
venoms
poisons
- used to antidote anti-cholinergic poisoning with organophsphate and nerve gas exposure
how to acetylcholinesterase inhibitors (AChEIs) prevent dementia?
inhibit cholinesterase enzyme from breaking down the neurotransmitter acetylcholine which decreases symptoms of dementia
SEs of AChEIs
Parasympathetic: bradycardia hypotension increased urination lacrimation bronchoconstriction N/V SLUDGE
Donepezil/Aricept
AChEI - reversible and centrally acting
Alzheimers
SLUDGE
Rivastigmine/exelon
AChEI - centrally acting and reversible
PATCH
mild to moderate Alzheimers dementia and Parkinsons dementia
weight gain (good because this dz tends towards weight loss/anorexia),
*better for more progressed cases, quicker onset, younger pt
what is a predictor of strong response to rivastigmine?
hallucinations
galantamine/razadyne
AChEI
mild to moderate alzheimers and used as brain enhancer
