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(UNI) Neuropharmacology (3rd Year) > Dementia > Flashcards

Dementia Flashcards

1
Q

Define dementia.

A

‘Chronic or persistent disorder in behaviour & higher intellectual function due to organic brain disease. Leading to memory disorders, changes personality, deterioration in personal care, impaired reasoning ability & disorientation.’

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2
Q

What stereotypes about elderly patients should be avoided?

A

Most old people do live independently, look after themselves, contribute to society, and don’t all need the same services.

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3
Q

What is the UK dementia burden?

A

Approx. £10 billion annually.

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4
Q

What are the general symptoms of dementia?

A

Memory loss, difficulties learning and retaining new information, difficulty completing complex tasks, reduced ability to reason or problem solve, impairment of spatial and visiospatial awareness, language problems, behavioural changes.

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5
Q

What rating scales are used for the assessment of dementia?

A

NPI, ADAS-Cog, ADL, MMSE.

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6
Q

What do the points in the MMSE scale mean?

A

21-26 points = mild AD, 10-20 points = moderate AD, <10 points = severe AD.

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7
Q

In what domains does MMSE assess cognition?

A

Orientation, registration, attention, recall, and language.

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8
Q

Who should be questioned to find out the practical implications of a patients dementia?

A

The patients carers and family as they have the most contact with the patient and know how they carry out everyday tasks.

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9
Q

What are the phases of dementia?

A

Mild cognitive impairment (MCI), mild, moderate, severe.

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10
Q

Can symptoms of dementia ever get better?

A

No, dementia is a degenerative condition where a patient gradually regresses.

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11
Q

What are the different types of dementia?

A

Alzheimer’s Disease, Vascular dementia, Parkinson’s Disease Dementia, Dementia with Lewy Bodies.

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12
Q

Define Alzheimer’s Dementia.

A

The classic form of dementia which comprises 60% of cases.

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13
Q

Define Vascular Dementia

A

Dementia with a vascular component, patients retain insight and personality for longer.

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14
Q

Define PDD/DLB

A

These two may be related. Patients show psychotic symptoms, extra-pyramidal symptoms, rigidity, bradykinesia, tremor.

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15
Q

What must be considered when treating PDD/DLB?

A

One should consider the balance between treating the emotional symptoms and the physical symptoms. Treating one often causes a deterioration in the other.

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16
Q

Can a true dementia diagnosis ever be given in a living patient?

A

No, a true diagnosis can only be given once the brain has been assessed post mortem.

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17
Q

What should be assessed/considered before initiating medication for dementia?

A

The patients drug chart should be assessed to see if any of their current medication impairs cognition.

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18
Q

What classes of medication impair cognition?

A

Sedative compounds (benzos, hypnotics, anti-psychotics), Anti-cholinergic drugs (anti-depressants, H2 antagonists), Physical drugs (furosemide, digoxin, warfarin).

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19
Q

What drugs can be used to enhance cognition?

A

Acetylcholinesterase inhibitors, Memantine.

20
Q

What acetylcholiesterase inhibitors are used?

A

Donepezil (Aricept), Galantamine (Reminyl), Rivastigmine (Exelon).

21
Q

Why is Tacrine not used?

A

It was never licensed due to hepatic toxicity.

22
Q

What is the depletion of acetylcholine in the moderate and severe stages of dementia?

A

40-90% depletion.

23
Q

Does a decrease in Ach correlate to a decrease in memory and cognition?

A

Yes.

24
Q

How long does it take for AchE inhibitors to arrest the decrease in cognition?

A

24 weeks.

25
Q

How many patients have a definite response to AchE inhibitor treatment? How many have some benefit over the placebo? Is this of clinical relevance?

A

25% of patients have a definite response, 40-50% of patients show some benefit over placebo. There may not be any clinical relevance to this.

26
Q

If a patient fails on one agent, should they be tried on another?

A

No, there is no evidence to suggest a second agent would be effective.

27
Q

The patient may experience dose related cholinergic events, how should this be combated?

A

One must start at low doses and increase slowly to improve tolerability.

28
Q

What are the main side effects of AchE inhibitor treatment?

A

The most common adverse effects are gastrointestinal adverse effects such as nausea, vomiting, diarrhoea, and abdominal pain. These may disappear but in some cases the drugs may be needing to be discontinued.

29
Q

What are serious and less common side effects of AchE inhibitor treatment?

A

Serious and less common events include convulsions and bradycardia.

30
Q

What drugs are inhibitors of donepezil and galantamine metabolism? What may this cause?

A

Erythromycin, fluoxetine, and paroxetine. Leading to breakthrough cholinergic events.

31
Q

What drugs are inducers of donepezil and galantamine metabolism? What may this cause?

A

Phenytoin, carbamazepine, and alcohol. Leading to reduced efficacy.

32
Q

What is memantine licensed to treat?

A

Moderately severe to severe AD.

33
Q

How does memantine work?

A

It binds to the NMDA receptors and blocks the glutamate-controlled receptor channels.

34
Q

What are the adverse effects associated with memantine treatment?

A

Hallucinations, confusion, dizziness, headache, tiredness.

35
Q

What is the incidence of behavioural symptoms in patients with dementia?

A

90%.

36
Q

What medications can cause delirium?

A

Sedatives, sympathiomimetics, anti-psychotics, anti-depressants, anti-cholinergics.

37
Q

What non-clinical issues may cause an exacerbation of BPSD symptoms?

A

Environmental factors (changes in location, temperature, noise). Lack of exercise. Communication difficulties. Boredom. Thirst. Hunger.

38
Q

What other treatments may be beneficial?

A

Complimentary and alternative therapies (e.g. aromatherapy with lavendar), sensory enhancement with light and music.

39
Q

Which sector of the healthcare system initiates clinical treatment and which sector takes over after initial treatment has begun.

A

Treatment is usually started by secondary care and when the patient is stable the prescribing is transferred to primary care.

40
Q

How should carers etc. be supported?

A

Adverse effects are not well recognised, so education and training are needed for those who treat and have contact with patients (nurses, patients, carers, etc.). Pharmacists can reduce the stress and burden by providing home delivery services, making their premises more accessible etc.

41
Q

How can the ‘swiss cheese model’ of error theory be related to dementia care?

A

If one follows the ‘Swiss Cheese’ model of error theory, when the patient becomes cognitively impaired there is a loss of one level of error prevention as the patient is unable to prevent medication errors from occurring. This puts an increased burden on the carer to prevent errors.

42
Q

What are the downsides of using compliance aids?

A

Limited space, stability issues, bacterial cross contamination, general uncleanliness.

43
Q

Do compliance aids help in the management of dementia?

A

Research has found that compliance aids may help in the early stages of dementia but are less likely to help when the disease is more advanced.

44
Q

How can dementia patients feel trapped in their care home?

A

Dosage regimens that have mid day doses as the staff may not be able to take the medication with them on day trips.

45
Q

How can social care visits be used to improve compliance?

A

Dosage regimens can be lines up with social care worker visits so they can administer the medication to the patients.

(UNI) Neuropharmacology (3rd Year) (20 decks)

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