Dementia QA

Question 1

Dementia + Alzheimer’s Disease Treatment

What to do if there three options are contraindicated

Answer 1

Monotherapy (acetylcholinesterase inhibitors)

• Donepezil
• Rivastigmine
• Gelantamine
• If acetylcholinesterase inhibitors are contraindicated what can you give Memantine

Question 2

Side effect of Donepezil

Answer 2

Neuroleptic malignant syndrome) – caution in hepatic impairment

Question 3

Side effect of Galantamine

Answer 3

SJS reaction) – avoid in renal impairment eGFR <9ml/min

Question 4

Side effect of Rivastigmine

Answer 4

Used in PD dementia – can cause GI disturbances – patch formulation)

Question 5

How to avoid the GI side effects of Rivastigmine

Answer 5

Give patch formulation

Question 6

What are the treatment options in mild to moderate Alzheimer’s disease

Answer 6

Memantine

Question 7

What are the side effects of Memantine

Answer 7

Side effects include constipation / fatigue

Question 8

Side effects of acetylcholinesterase inhibitors

Answer 8

DUMBELS

• Diarrhoea
• Urination
• Muscle weakness
• Bronchospasms
• Bradycardia
• Emesis
• Lacrimation
• Salvation

Question 9

Management of non-cognitive symptoms – for example dementia with Lewy bodies

Answer 9

• Acetylcholisterase inhibitors rivastigmine

Question 10

Management of non-cognitive symptoms – for example dementia extreme agitation

Answer 10

• Oral benzodiazepines
• Antipsychotics
• IM (oral haloperidol / olanzapine / lorazepam)

Question 11

If antiphysotic are given to pt to consider what is the consideration that need to be made

Answer 11

• At lowest dose
• Review at 6 months
• Antipsychotics can sometimes worsen features
  MHRA alert with pt who have increase risk of stroke and death with antipsychotics used in elderly patients with dementia.