Dementia

Question 1

What drugs are approved for treatment of mild cognitive impairment?

Answer 1

None

Question 2

What class of medications are on the Beers Criteria because they cause short-term confusion and memory loss? No proof it causes dementia, weak with low dose/intermittent use.

Answer 2

Anticholinergics

Question 3

What are a few non-pharm tx options for patients with dementia?

Answer 3

• Stable, low stress environment
• Soothing atmosphere (light, music, aroma, acupuncture, massage therapy)
• Providing security objects (consistent caregiver, blanket)

Question 4

What is the workhorse of newer cholinesterase inhibitors?

Answer 4

Donepezil

Question 5

How long should you administer the cholinesterase inhibitors for as part of a drug trial?

Answer 5

8 weeks, continue if improvement

Question 6

When should you consider stopping drug therapy?

Answer 6

• No detectable benefit by 3-6 months
• ADRs
• Pt is severely affected (bedridden, incontinent, nonverbal)

Question 7

How long should you taper anticholinergics to reduce possible discontinuation symptoms?

Answer 7

4 weeks

Question 8

What are the main ADRs associated with cholinesterase inhibitors?

Answer 8

• Anorexia/wt loss and GI intolerance most common
• Insomnia (AM dosing)
• Bradycardia, agitation, and syncope (more falls)

Question 9

What drug should be used in treatment of moderate to severe dementia?

Answer 9

Memantine

Question 10

What are the steps for common neuropsych symptoms such as hallucination, delusion, or agitation?

Answer 10

1. Rule out common etiologies
2. Nonpharm options
3. Consider antidepressants (SSRI or trazadone), START LOW AND SLOW
4. Atypical antipsychotics (ass with increased mortality - CV and infection)

Question 11

What is associated with decreased risk of cog impairment and dementia?

Answer 11

Long-term, regular exercise