Dementia COPY Flashcards
What is the most common type of dementia
Alzheimers disease
What is dementia & name some symptoms
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
Other common types of dementia (not AD)
○ Vascular dementia (due to cerebrovascular disease)
○ Dementia with Lewy bodies
○ Mixed dementia
○ Frontotemporal dementia
Non-drug treatment
- 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
Management of cognitive symptoms - considering the drugs they are already prescribed
- 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!
Drugs with antimuscarinic effects include
○ Antidepressants e.g. amitriptyline, paroxetine
○ Antihistamines e.g. chlorphenamine, promethazine
○ Antipsychotics e.g. olanzapine, quetiapine
○ Urinary antispasmodic e.g. solifenacin, tolterodine
How would you initiate drug treatment in newly diagnosed Alzheimers disease
Newly diagnosed: only initiate drug treatment under advice of specialist clinical experienced in the management of AD
Treatment of mild to moderate Alzheimers disease
○ 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
Treatment of severe Alzheimer’s disease
Memantine
Step up treatment in AD if they develop moderate or severe disease
- 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
Discontinuing ACh-esterase inhibitor treatment in moderate AD
- 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
Treatment of mild to moderate dementia with Lewy bodies
- 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)
Treatment of severe dementia with Lewy bodies
Donepezil or rivastigmine (both unlicensed indications)
When should Ach-esterase inhibitors or memantine be considered in vascular dementia
- Both unlicensed indications
- Only consider if they have suspected co-morbid AD, PD dementia or dementia with Lewy bodies
Use of Ach-esterase inhibitors or memantine in pt with frontotemporal dementia or cognitive impairment caused by MS
NOT recommended