Dementia and alzheimer's

Question 1

What is the best-known cause of dementia?

Answer 1

Alzheimer’s disease

Question 2

What are some of the symptoms of AD?

Answer 2

Memory
Disorientation 
Repetition 
Misplacing things
Confusion

Question 3

What are the two abnormal proteins that build in the brain in AD?

Answer 3

Tau tangles

B-amyloid plaques

Question 4

What is the amyloid cascade hypothesis?

Answer 4

APP is found in the membrane of neurones. When it gets cut up by alpha-secretase and gamma-secretase it is fine - soluble peptide.
When APP gets broken up by B-secretase and gamma-secretase, the peptide formed is insoluble and creates a monomer called amyloid-B which is sticky and clumps together to form oligomers -> plaques

Question 5

What are the three main types of dementia?

Answer 5

AD
Dementia with lewy bodies
Vascular dementia

Question 6

What are the three stages of dementia severity?

Answer 6

Mild - prominent memory loss. Core activities of daily function are maintained but higher level functions impaired
Moderate - worsening cognition. Core activities of daily function now affected, Challenging behaviour may become more prominent
Severe - apathy and dependency prominent. Many patients receiving 24hr care

Question 7

How is dementia diagnosed according to ICD-10?

Answer 7

Memory loss must be present plus decline in one other domain of cognition e.g. judging, reasoning, planning such that it interferes with activities of daily life
Some change in social behaviour
Decline lasting at least 6 months

Question 8

Drug treatments are only licensed for which type of dementia?

Answer 8

AD

Question 9

What is the main drug treatment for AD?

Answer 9

Acetylcholinesterase inhibitors

Question 10

Name a acetylcholinesterase inhibitor used in the treatment of AD

Answer 10

Rivastigmine

Donepezil

Question 11

Name the NMDA antagonist that is licensed for use in AD

Answer 11

Memantine

Question 12

What are some of the non-pharmacological treatment options for dementia?

Answer 12

Lifestyle factor modification e.g. stopping smoking, exercise, 5-a day
Routine and familiarity are important for maintaining independence so keep diary etc.
Use of colour and increasing size helps to enhance visibility
Cognitive stimulation therapy - promotes calmness and engagement with others
Treat co-morbid depression/sleep disorders

Question 13

When is memantine used in the treatment of AD?

Answer 13

Moderate AD in patients who cannot take AChE inhibitors or in severe AD

Question 14

When should combination therapy with AChE inhibitor and memantine be considered?

Answer 14

Consider in moderate disease

Should be offered in severe disease

Question 15

Which is the lowest cost AChE inhibitor that is usually used in AD?

Answer 15

Donepezil

Question 16

Which drugs should not be used in the treatment of vascular dementia?

Answer 16

AChE inhibitors or memantine.

Unless used to treat co-morbid AD

Question 17

What are the treatment options for dementia with lewy bodies?

Answer 17

Donepezil or rivastigmine in mild-moderate
Galantamine in severe
Offer memantine if AChE inhibitors C/I

Question 18

If patient has poor tolerability to one AChE inhibitor does that meant they will have poor tolerability to others?

Answer 18

No

Question 19

When starting treatment with galantamine, when can the dose be increased?

Answer 19

Start low and increase dose after 1 month

Question 20

When starting treatment with memantine, when can dose be increased?

Answer 20

Start low and increase after 1 week

Question 21

When starting treatment with rivastigmine, when can dose be increased?

Answer 21

Start low and increase after 2 weeks

Question 22

Which drug is available in a patch formulation?

Answer 22

Rivastigmine - site of patch should be changed daily and previous sites should be avoided for 14 days.

Question 23

Other than cognitive symptoms, what symptoms may dementia patients experience?

Answer 23

Behavioural and psychological symptoms

Question 24

List some behavioural and psychological symptoms of dementia

Answer 24

Psychosis
Agitation
Wandering
Aggression

Question 25

How can BPSD be managed?

Answer 25

Try to rule out other causes of BPSD using PAIN acronym:
Physical problems - infection, pain, constipation?
Activity related - washing, dressing?
Iatrogenic - side effects of meds?
Noise and other environmental factors such as lighting

Question 26

When are meds used in BPSD?

Answer 26

Only in severe distress or immediate risk of harm to others or person with dementia

Question 27

What is the licensed drug for BPSD?

Answer 27

Risperidone