Dementia

Question 1

Types of behaviour and psychological sx of dementia

Answer 1

Mood Symptoms e.g. depression, anxiety, apathy, euphoria

Psychotic symptoms e.g. delusions, hallucinations, misidentification

Restless/Agitated behaviours e.g. Aggression, agitation, wandering

Disinhibited behviours e.g. sexually inappropriate behaviour

(Ref: Minimising Psychotropic use for BPSD, 2015)

Question 2

Are psychotropic medications useful for wandering and vocalisation?

Answer 2

No

Question 3

Non pharmacological strategies for BPSD (verbal aggression) ?

Answer 3

Sounds e.g. mountain stream, ocean waves /Preferred music
Staff training (e.g. psychoeducation, behaviour management techniques)
Individual recreational activities
Aromatherapy

Question 4

T or F

Asymptomatic patients should not have a urine dipstick or a urine mcs?

Answer 4

T

Question 5

Non Pharmacological pain management

Answer 5

OT e.g. walking frames
Physical therapy e.g Exercise, foot orthtoics, TENS,
Psychological approaches e.g. CBT
Comlementary or alternative therapy e.g. Acupuncutre , Massage,

Question 6

What are the screening questionnaires used for dementia?

Answer 6

MMSE
General Practitioner assessment of CoGnition (GPCoG)
Rowland universal Dementia Assessment scale (RuDAs) –>
useful for non english speaking backgrounds
The Kimberley Indigenous Cognitive Assessment tool (KICA) dementia assessment instrument may be

Question 7

What are two types of medications for mild to moderate alzheimer’s disease?

Answer 7

Acetylcholinesterase inhiitors e.g. Donepezil, rivastigmine, Galantamine

NMDA glutamate receptor inhibitor e.g. Memantine

Question 8

Dementia definition:

Ref: dementia and driving 2012)

Answer 8

progressive memory loss and at-least 1 other cognitive domain e.g.
Aphasia: problems with language
Agnosia: failure to recognise what objects are used for
Apraxia: inability to carry out purposeful movements e.g. difficulty dressing
Executive dysfunction: impaired planning, sequential organisation and attention e.g. problem solving, reluctance to take change routines
(Ref: dementia and driving 2012)
(Ref: Dementia 2013 Check)

Question 9

What are the common types of dementia?

Answer 9

ascular dementia (10-20%) 
Lew Body Demntia (15-20%) 
Frontal lobe dementia 
Parkinsons disease with dementia 
Normal pressure hydrocephalus 
Post Traumatic
Medications
Alcohol 
Anoxic encephalopathy 
Down Syndrome 
AIDS 

(Ref: Silverbook)

Question 10

Medications to cease

Answer 10

Anticholinergic drugs e.g. digoxin, warfarin, frusemide, Oxybutynin, TCA’s
The older the antiepelptic worse it is for congition e.g. sodium valproate, phenytoid
Benzodiazepams

(ref: dementia and DOL’s Swindon GP Education)

Question 11

What are the side effects of cholinesterase inhibitors?

Answer 11

GI: anorexia, nausea, diarrhoea, vomiting
Urge to daefacate, urinate
Sleep disturbances, nightmares
Inc risk of epileptic fits

(RACGP Check Dementia 2013)