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PR - CNS > DEMENTIA: GENERAL INFO > Flashcards

DEMENTIA: GENERAL INFO Flashcards

1
Q

Dementia

A

Progressive clinical syndrome characterised by range of cognitive and behavioural symptoms

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2
Q

Types of dementia

A

Alzheimer’s dementia
Vascular dementia
Dementia with Lewy bodies
Mixed dementia
Frontotemporal dementia

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3
Q

Risk factors

A

Ageing
Alcohol, smoking
Mild cognitive impairment
Genetics
PD
Cerebrovascular disease
CVD

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4
Q

Symptoms of dementia

A
  1. Cognitive dysfunction
    - e.g. problems with memory
  2. Non-cognitive symptoms
    - Psychiatric and behavioural problems
    - e.g. changes in personality
  3. Problems with daily living
    - e.g. washing and dressing
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5
Q

Cognitive symptoms

A

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

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6
Q

Diagnosing dementia

A
  1. Take history of cognitive, behavioural and psychological symptoms
  2. Conduct a physical examination
    - undertake appropriate blood and urine tests to exclude
    reversible causes of cognitive decline
  3. Use cognitive tests
    - e.g. 10-point cognitive screener Or Test Your Memory (TYM)
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7
Q

Reversible causes of decline in cognitive function - could be mistaken for dementia

A
  • Associated infection/delirium e.g. UTI
  • Depression
  • Brain tumours
  • Hypothyroidism
  • Vit def
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8
Q

If a person gets a
normal score using the cognitive tests, does that rule out dementia?

A

No

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9
Q

If a reversible cause of dementia has been investigated and dementia is still suspected, what do you do?

A

refer to a specialist dementia diagnostic service e.g. Memory clinic or community old age psychiatry service

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10
Q

INCREASING WHAT NEUROTRANSMITTER ALLEVIATES DEMENTIA?

A

Acetylcholine
* We use acetylcholine esterase inhibitors.
* INHIBITING THE PROTEIN THAT BREAKS IT DOWN

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11
Q

NON DRUG TREATMENT: MILD - MODERATE DEMENTIA

A
  • group cognitive stimulation programme
  • group reminiscence therapy (life stories to improve psychological well being)
  • cognitive rehab
  • occupational therapy to support daily functional ability
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12
Q

TREATMENT: MILD-MODERATE DEMENTIA

A

Monotherapy with an ACh-esterase inhibitor:
Donepezil
Rivastigamine
Galantamine

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13
Q

TREATMENT: MODERATE-SEVERE DEMENTIA

A

Memantine

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14
Q

Can AChE inhibitors and Memantine be taken together for AD?

A

Yes can + memantine

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15
Q

Lewy bodies Treatment

A
  • Ofter Donepezil or
    Rivastigmine
  • Ofter Glantantamine if
    Donepezil or Rivastigmine not tolerated/Cl
  • Offer Memantine if unable to tolerate/Cl to AChE
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16
Q

Vascular dementia Treatment

A
  • DO NOT OFFER AChE or memantine (according to
    NICE)
  • Only if they have suspected co-morbid alzheimer’s disease, or other co-morbid dementia
17
Q

Cautions for use of AChE i

A
  1. Sick sinus syndrome or cardiac conduction conditions
    (e.g. Sinoatrial block)
  2. Those susceptible to peptic ulcers
  3. History of Asthma/COPD (AChE increase bronchial secretions and may exacerbate asthma/COPD)
  4. Renal/hepatic impairment
18
Q

Common side effects of AChE i

A

GI
- N+V
- Anorexia
- Ulceration

CNS
- Alertness, agitation
- Hallucinations
- Dizziness
- Insomnia

GUS
- UI

Cardiac
- Brady
- SA/AV block

19
Q

Some commonly prescribed drugs are associated with increased antimuscarinic (anticholinergic) burden and therefore cognitive impairment. Their use should be minimised

A

Antidepressants
- Amitriptyline, paroxetine

Antihistamine
- Chlorphenamine
- Promethazine

Antipsychotic
- Olanzapine
- Quetiapine

Urinary antispasmodics
- Solifenacin
- Tolterodine

20
Q

TREATMENT OF SYMPTOMS OF DEPRESSION AND ANXIETY IN DEMENTIA

A

CBT, Antidepressants reserved for pre-existing severe mental health

21
Q

WHAT ANTIDEPRESSANTS CAN BE USED TO MANAGE COGNITIVE SYMPTOMS IN DEMENTIA?

A

o Amitriptyline, paroxetine

22
Q

WHAT ANTIHISTAMINE CAN BE USED TO MANAGE COGNITIVE SYMPTOMS IN DEMENTIA?

A

o Chlorphenamine, promethazine

23
Q

WHAT URINARY ANTISPASMODIC CAN BE USED TO MANAGE COGNITIVE SYMPTOMS IN DEMENTIA?

A

o Solifenacin
o Tolterodine

24
Q

MANAGEMENT OF NON-COGNITIVE SYMPTOMS

A

Treated with benzos or antipsychotics

risperidone
haloperidol

25
Q

ANTIPSYCHOTICS IN ELDERLY PATIENTS WITH DEMENTIA

A

Increased risk of stroke, small increased risk of death when using
Risk of falls (risperidone)
o Lowest effective dose for shortest time
o Regular review at least every 6 weeks

26
Q

When can you offer pt with dementia antipsychotics?

A

only offer to pt if at risk of harming themselves or others
experiencing agitation, hallucinations or delusions that are causing severe distress

27
Q

if you do give antipsychotics in dementia, how often do you need to review

A

regularly at least every 6 weeks

28
Q

ANTIPSYCHOTICS AND DEMENTIA can cause

A

Increased ACh = Parasympathetic SFx – rest and digest and secrete
Diarrhoea
Urinary incontinence
Muscle weakness
Bradycardia
Bronchospasms
Emesis
Lacrimation
Salivation

29
Q

Sleep disturbances management non drug

A

including sleep hygiene education
exposure to daylight
increasing exercise and activity

30
Q

5 drug classes and examples - use with caution dementia

A

TCAs
Antiemeitcs e.g. metoclopramide
Analgesics e.g. pethidine, tramadol
Sedatives e.g. LA benzodiazepenes or antipsyhtocis
Antihtiasmines e.g. chlorphenamine

PR - CNS (61 decks)

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