Dementia therapeutics

Question 1

Causes of dementia

Answer 1

Substance/alcohol misuse, hypothyroidism, normal pressure hydrocephalus, syphilis, b12/folate deficiency

Question 2

Which drugs exacerbate dementia sx

Answer 2

Anticholinergics
Sedatives - benzos
Dopamine agonists - pramipexole
Antidepressants - amitriptyline

Question 3

ACEi

Answer 3

• Acetylcholine is broken down in synapse
• More acetylcholine in cleft is good
• Donepezil, rivastigmine, galantamine
• Improve motivation, anxiety, confidence, memory
• S/e: agitation, decreased appetite, diarrhoea, fatigue

Question 4

Memantine

Answer 4

• Low affinity, non-competitive antagonist of NMDA receptors
• NMDA used in learning in memory
• Over-activation of NMDA causes excessive Ca2+ influx via channel pore = neurotoxicity
• Memantine decreases influx of ions through channel pore - neuroprotective
• Prescribed in AD
• S/e: impaired balance, constipation, dizziness, hypertension

Question 5

How do you treat anxiety/depression in dementia pts?

Answer 5

CBT or SSRI - avoid benzos