Dementia COPY Flashcards

1
Q

What is the most common type of dementia

A

Alzheimers disease

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2
Q

What is dementia & name some symptoms

A

Progressive clinical syndrome characterised by a range of cognitive and behavioural symptoms that may include
○ Memory loss
○ Problems with reasoning and communication
○ Change in personality
○ Reduced ability to carry out daily activities e.g. washing and dressing

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3
Q

Other common types of dementia (not AD)

A

○ Vascular dementia (due to cerebrovascular disease)
○ Dementia with Lewy bodies
○ Mixed dementia
○ Frontotemporal dementia

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4
Q

Non-drug treatment

A
  • Pt with ALL types of mild to moderate dementia presenting with cognitive symptoms should be given the opportunity to participate in a structured group cognitive stimulation programme
    • Group reminiscence therapy (use of life stories to improve psychological well being) and cognitive rehabilitation or occupational therapy to support daily functional ability, should also be considered
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5
Q

Management of cognitive symptoms - considering the drugs they are already prescribed

A
  • Some commonly prescribed drugs are associated with increased antimuscarinic (anticholinergic) burden - THUS cognitive impairment
    ○ Hence their use should be minimised
    ○ Review and stop/use lowest effective dose!
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6
Q

Drugs with antimuscarinic effects include

A

○ Antidepressants e.g. amitriptyline, paroxetine
○ Antihistamines e.g. chlorphenamine, promethazine
○ Antipsychotics e.g. olanzapine, quetiapine
○ Urinary antispasmodic e.g. solifenacin, tolterodine

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7
Q

How would you initiate drug treatment in newly diagnosed Alzheimers disease

A

Newly diagnosed: only initiate drug treatment under advice of specialist clinical experienced in the management of AD

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8
Q

Treatment of mild to moderate Alzheimers disease

A

○ 1st line: Monotherapy with donepezil, galantamine or rivastigmine (ACh-esterase inhibitors)
○ If Ach-esterase inhibitors are not tolerated or contraindicated, an alternative in MODERATE AD is memantine

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9
Q

Treatment of severe Alzheimer’s disease

A

Memantine

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10
Q

Step up treatment in AD if they develop moderate or severe disease

A
  • Mild to moderate AD, 1st line: Monotherapy with donepezil, galantamine or rivastigmine (ACh-esterase inhibitors)
  • In pt already receiving an ACh-esterase inhibitor to treat AD, consider adding memantine if they develop moderate or severe disease
    ○ Memantine can be initiated in primary care without advice from a specialist clinician
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11
Q

Discontinuing ACh-esterase inhibitor treatment in moderate AD

A
  • In pt with moderate AD, discontinuing ACh-esterase inhibitor treatment can cause a substantial worsening in cognitive function
  • Do not discontinue treatment based on disease severity alone
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12
Q

Treatment of mild to moderate dementia with Lewy bodies

A
  • Donepezil or rivastigmine (both unlicensed indication)
  • Consider galantamine (unlicensed indication) only if treatment with the above not tolerated
  • If Ach-esterase inhibitors contraindicated or not tolerated, consider memantine (unlicensed indication)
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13
Q

Treatment of severe dementia with Lewy bodies

A

Donepezil or rivastigmine (both unlicensed indications)

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14
Q

When should Ach-esterase inhibitors or memantine be considered in vascular dementia

A
  • Both unlicensed indications
  • Only consider if they have suspected co-morbid AD, PD dementia or dementia with Lewy bodies
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15
Q

Use of Ach-esterase inhibitors or memantine in pt with frontotemporal dementia or cognitive impairment caused by MS

A

NOT recommended

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16
Q

Examples of non-cognitive symptoms

A

Agitation
Aggression
Distress
Psychosis

17
Q

Management of non-cognitive symptoms

A
  • Pt with dementia should be offered psychosocial and environmental interventions e.g. counselling and management of pain & delirium to reduce distress
  • Antipsychotics should only be offered to pt with dementia if they are at risk of harming themselves or others, or experiencing agitation, hallucinations or delusions that are causing them severe distress
18
Q

MHRA: antipsychotics

A

○ Increased risk of stroke
○ Small increased risk of death
○ When antipsychotics are used in elderly pt with dementia
- Thus balance risks vs benefit carefully, including PHx of stroke, TIA and any other risk factors for cerebrovascular disease such as hypertension, diabetes, smoking and AF
- Antipsychotics should be used at lowest effective dose & for the shortest time possible
- Regular review at least every 6 weeks

19
Q

Use of antipsychotics in patients with dementia with Lewy bodies or PD dementia

A

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

quetiapine and clozapine – These drugs are mostly used if a person has dementia with Lewy bodies or Parkinson’s disease dementia. This is because they interfere less with drugs that treat other symptoms of these conditions. However, there is very little evidence that they are effective. They may also cause the person to become drowsy or dizzy, which can increase the risk of falling

20
Q

Side effects of acetylcholinesterase inhibitors

A

increased ACh = parasympathetic SE (rest, digest, secrete)

21
Q

DUMB BELS

A

side effects of ACHesterase inhibitors