DEMENTIA: GENERAL INFO Flashcards
Dementia
Progressive clinical syndrome characterised by range of cognitive and behavioural symptoms
Types of dementia
Alzheimer’s dementia
Vascular dementia
Dementia with Lewy bodies
Mixed dementia
Frontotemporal dementia
Risk factors
Ageing
Alcohol, smoking
Mild cognitive impairment
Genetics
PD
Cerebrovascular disease
CVD
Symptoms of dementia
- Cognitive dysfunction
- e.g. problems with memory - Non-cognitive symptoms
- Psychiatric and behavioural problems
- e.g. changes in personality - Problems with daily living
- e.g. washing and dressing
Cognitive symptoms
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
Diagnosing dementia
- Take history of cognitive, behavioural and psychological symptoms
- Conduct a physical examination
- undertake appropriate blood and urine tests to exclude
reversible causes of cognitive decline - Use cognitive tests
- e.g. 10-point cognitive screener Or Test Your Memory (TYM)
Reversible causes of decline in cognitive function - could be mistaken for dementia
- Associated infection/delirium e.g. UTI
- Depression
- Brain tumours
- Hypothyroidism
- Vit def
If a person gets a
normal score using the cognitive tests, does that rule out dementia?
No
If a reversible cause of dementia has been investigated and dementia is still suspected, what do you do?
refer to a specialist dementia diagnostic service e.g. Memory clinic or community old age psychiatry service
INCREASING WHAT NEUROTRANSMITTER ALLEVIATES DEMENTIA?
Acetylcholine
* We use acetylcholine esterase inhibitors.
* INHIBITING THE PROTEIN THAT BREAKS IT DOWN
NON DRUG TREATMENT: MILD - MODERATE DEMENTIA
- group cognitive stimulation programme
- group reminiscence therapy (life stories to improve psychological well being)
- cognitive rehab
- occupational therapy to support daily functional ability
TREATMENT: MILD-MODERATE DEMENTIA
Monotherapy with an ACh-esterase inhibitor:
Donepezil
Rivastigamine
Galantamine
TREATMENT: MODERATE-SEVERE DEMENTIA
Memantine
Can AChE inhibitors and Memantine be taken together for AD?
Yes can + memantine
Lewy bodies Treatment
- Ofter Donepezil or
Rivastigmine - Ofter Glantantamine if
Donepezil or Rivastigmine not tolerated/Cl - Offer Memantine if unable to tolerate/Cl to AChE
Vascular dementia Treatment
- DO NOT OFFER AChE or memantine (according to
NICE) - Only if they have suspected co-morbid alzheimer’s disease, or other co-morbid dementia
Cautions for use of AChE i
- Sick sinus syndrome or cardiac conduction conditions
(e.g. Sinoatrial block) - Those susceptible to peptic ulcers
- History of Asthma/COPD (AChE increase bronchial secretions and may exacerbate asthma/COPD)
- Renal/hepatic impairment
Common side effects of AChE i
GI
- N+V
- Anorexia
- Ulceration
CNS
- Alertness, agitation
- Hallucinations
- Dizziness
- Insomnia
GUS
- UI
Cardiac
- Brady
- SA/AV block
Some commonly prescribed drugs are associated with increased antimuscarinic (anticholinergic) burden and therefore cognitive impairment. Their use should be minimised
Antidepressants
- Amitriptyline, paroxetine
Antihistamine
- Chlorphenamine
- Promethazine
Antipsychotic
- Olanzapine
- Quetiapine
Urinary antispasmodics
- Solifenacin
- Tolterodine
TREATMENT OF SYMPTOMS OF DEPRESSION AND ANXIETY IN DEMENTIA
CBT, Antidepressants reserved for pre-existing severe mental health
WHAT ANTIDEPRESSANTS CAN BE USED TO MANAGE COGNITIVE SYMPTOMS IN DEMENTIA?
o Amitriptyline, paroxetine
WHAT ANTIHISTAMINE CAN BE USED TO MANAGE COGNITIVE SYMPTOMS IN DEMENTIA?
o Chlorphenamine, promethazine
WHAT URINARY ANTISPASMODIC CAN BE USED TO MANAGE COGNITIVE SYMPTOMS IN DEMENTIA?
o Solifenacin
o Tolterodine
MANAGEMENT OF NON-COGNITIVE SYMPTOMS
Treated with benzos or antipsychotics
risperidone
haloperidol
