Dementia - general info

Question 1

Dementia

Answer 1

A group of symptoms that affects memory, thinking and interferes with daily life.
Caused by damage to the brain - can occur due to diseases such as AD, stroke or PD

Question 2

Cognitive symptoms

Answer 2

Memory loss
Difficulty thinking e.g. concentration or problem solving
Language e.g. can’t find the right word.
Orientation e.g. losing track of date/time

Question 3

Non-cognitive symptoms

Answer 3

Psychiatric and behavioural problems e.g. delusions or aggression
Difficulties with daily activities

Question 4

Mild-moderate AD

Answer 4

Acetylcholinesterase inhibitors (anticholinesterase)
* Donepezil
* Galantamine
* Rivastigmine
CONTRAINDICATED IN MODERATE/SEVERE AD

Question 5

Donepezil

Answer 5

Neuroleptic malignant syndrome.
Risk increased with concomitant antipsychotics

Question 6

Galantamine

Answer 6

Serious skin reactions can occur.
Stop at first appearance of skin rash

Question 7

Rivastigmine

Answer 7

Used in PD
GI disturbances - withhold until resolved
Transdermal patches = less GI side effects

Question 8

Acetylcholine

Answer 8

Neurotransmitter crucial for memory and learning.

Question 9

Acetylcholinesterase

Answer 9

Enzyme that breaks down acetylcholine.

Question 10

Acetylcholinesterase inhibitors - MoA

Answer 10

In AD, cholinergic neurons that produce acetylcholine are lost.
Acetylcholinesterase inhibitors (donepezil, rivastigmine + galantamine) inhibit acetylcholinesterase, which leads to high acetylcholine levels.
Acetylcholine stays active in the brain for a longer time.
Improves cognitive function and slow down memory loss/decline.

Question 11

Cholinergic side effects

Answer 11

Acetylcholinesterase inhibitors have cholinergic side effects.
Symptoms and physiological responses that occur due to increase activity of acetylcholine.
DUMB BELS

Question 12

DUMB BELS

Answer 12

Diarrhoea
Urination
Muscle weakness, muscle cramps, miosis
Bronchospasm

Bradycardia
Emesis (vomiting)
Lacrimation (teary eyes)
Salivation/ sweating

Question 13

Moderate-severe AD

Answer 13

NMDA glutamate receptor antagonist
* Memantine

Question 14

AD + NMDA activity

Answer 14

AD = excessive activation of NMDA receptors = excitotoxicity (high levels of intracellular calcium which contributes to neuronal damage).

Question 15

NMDA glutamate receptor antagonist

Answer 15

Memantine modulates NMDA receptor activity by blocking excess calcium influx.
Helps regulate excitotoxicity.

Question 16

Management of non-cognitive symptoms

Answer 16

Anti-psychotic rugs for severe non-cognitive symptoms causing significant distress or immediate risk of harm to self or others.
- Oral benzodiazepines or antipsychotic.
- IM needed = haloperidol, olanzapine, lorazepam

Question 17

Anti-psychotic drugs - MHRA advice

Answer 17

MHRA advice (2009): CLEAR increased risk of stroke and death when antipsychotics are used in elderly patients with dementia.
Carefully assess benefit vs. risk, looking at:
- Stroke/transient ischaemic attack
- Cerebrovascular disease risk factors (HF, diabetes, AF, smoking)