Dementia

Question 1

Dementia is a progressive clinical syndrome characterised by a range of cognitive and behavioural symptoms, list some of these symptoms (4)

Answer 1

1) Memory loss
2) Problems with reasoning and communication
3) A change in personality
4) Reduced ability to carry out daily activities such as washing or dressing

Question 2

list the different types of dementia (5)

Answer 2

1) Alzheimer’s disease (most common)
2) Vascular dementia (due to cerebrovascular disease)
3) Dementia with Lewy bodies
4) Mixed dementia
5) Frontotemporal dementia

Question 3

Outline the non-drug treatments for patients with mild to moderate dementia (3)

Answer 3

If presenting with cognitive symptoms offer:

1) Cognitive stimulation therapy
2) Group reminiscence therapy
3) Cognitive rehabilitation or occupational therapy to support daily functional ability

Question 4

Explain why the use of anticholinergic drugs should should be minimised in dementia patients

Answer 4

antimuscarinic (anticholinergic) burden: they lead to cognitive impairment

Question 5

list some commonly prescribed drugs associated with increased antimuscarinic (anticholinergic) burden (4)

Answer 5

1) Antidepressants (e.g. amitriptyline, paroxetine),
2) Antihistamines (e.g. chlorphenamine, promethazine)
3) Antipsychotics (e.g. olanzapine, quetiapine)
4) Urinary antispasmodics (e.g. solifenacin , tolterodine)

Question 6

which drugs are first-line options In newly diagnosed mild-to-moderate Alzheimer’s disease? (initiated under specialist)

Answer 6

1) Monotherapy with donepezil , galantamine, or rivastigmine (acetylcholinesterase inhibitors)
2) if above C/I Memantine is a suitable alternative

Question 7

what is the drug of choice in patients with severe Alzheimer’s disease?

Answer 7

Memantine

Question 8

In patients already receiving ACH inhibitors to treat Alzheimer disease, what additional drug can be considered if they progress to moderate or severe disease?

Answer 8

1) Memantine
2) in this case, it can be initiated in primary care without advice from a specialist clinician. (But initial diagnosis and treatment needs to be done by a specialist)

Question 9

what are the treatment options for mild-to-moderate dementia with Lewy bodies (non-Alzheimer’s dementia)?

Answer 9

1) Donepezil or Rivastigmine (also used in severe)
2) Galantamine can be considered only if both of the above are not tolerated
3) Memantine an be considered as an alternative in whom ACH inhibitors are C/I or not tolerated
↳ All of these drugs are unlicensed for this indication

Question 10

which drugs should be considered for vascular dementia?

Answer 10

ACH inhibitors [unl] or memantine [unl]

Question 11

which drugs are not recommended in patients with frontotemporal dementia or cognitive impairment caused by multiple sclerosis?

Answer 11

ACH inhibitors and Memantine

Question 12

list 4 non-cogitative symptoms of dementia

Answer 12

Agitation, aggression, distress and psychosis

Question 13

Outline when antipsychotic drugs should be offered to patients with dementia

Answer 13

1) At risk of harming themselves or others

2) Experiencing agitation, hallucinations or delusions that are causing severe distress

Question 14

The MHRA reported that when antipsychotic drugs are used in elderly patients with dementia what is more likely to occur?

Answer 14

Increased risk of stroke and a small increased risk of death

Question 15

Antipsychotic drugs should be used at the lowest effective dose and for the shortest time possible in those with dementia. How often should these drugs be be reviewed?

Answer 15

regular review at least every 6 weeks

Question 16

Explain what antipsychotic drugs can cause in patients who have dementia with Lewy bodies or Parkinson’s disease dementia

Answer 16

worsen the motor features of the condition, and in some cases cause severe antipsychotic sensitivity reactions

Question 17

Outline how depression or anxiety should be managed in those with mild-to-moderate dementia

Answer 17

1) Psychological treatments (e.g. CBT)
2) Multisensory stimulation
3) Relaxation
4) Animal-assisted therapies
↳ (antidepressants should be reserved for pre-existing severe mental health problems)

Question 18

Patients with dementia should be offered non-drug treatment approaches to manage sleep problems and insomnia. List some examples of these treatments (3)

Answer 18

1) Sleep hygiene education
2) Exposure to daylight
3) Increasing exercise and activity