Dementia

Question 1

Symptoms: Cognitive

Answer 1

Memory loss, difficulty thinking, language, orientation

Question 2

Symptoms: Non Cognitive

Answer 2

Psychiatric and behavioural problems, difficulties with ADLs

Question 3

Management of mild-moderate cog. symptoms

Answer 3

Acetylcholinesterase inhibitors (CI in severe):
Donepezil (risk of neuroleptic malignant syndrome - esp with antipsychotics)
Galantamine (stop at first sign of skin rash-risk of skin reactions such as SJS)
Rivastigmine (used in Parkinson’s, can cause GI disturbances, withhold until resolved)

Question 4

Management of moderate-severe cog. symptoms

Answer 4

NMDA Glutamate receptor antagonist

Memantine

Question 5

Cholinergic ADRs

Answer 5

DUMB BELS
Diarrhoea, Urination, Muscle weakness/cramps, Bronchospasm
Bradycardia, Emesis, Lacrimation (teary eyes), Salivation/sweating

Question 6

Management of non-cog symptoms

Answer 6

Antipsychotics - MHRA warning (inc risk of stroke & death in elderly dementia patients). Only for severe symptoms causing significant distress or immediate risk of harm to self/others
Extreme violence, aggression, agitation: benzos/antipsychotics
Dementia with Lewy Body (Parkinson’s): Rivastigmine