Dementia Treatment Flashcards
What are the non-pharmacologic treatment of dementia?
Communication is kept simple and direct
Calmness, firmness, and supportiveness in times of difficulty
Consistent and calm envireonment
Use of frequent reminders, explanations and orientatons
Adjust as patient gradually declines
What are the treatments for cognitive sx?
Cholinesterase inhibitors and memantine
What are the treatments for non-cognitive sx?
Symptomatic psychiatric treatment
What are non-cognitive sx?
Psychosis and behavioral disturbances
What is the MOA of cholinesterase inhibitors?
Blocks the acetylcholinesterase enzyme on the post-synaptic membrane, that normally breaks down acetylcholine, allowing for more acetylcholine in the post-synaptic cleft
How does efficacy vary across the cholinesterase inhibitors?
It does not. Relatively similar across class
When do we recommend a trial of cholinesterase agents?
Patients with AD, vascular, mixed, Lewy Body, or Parkinson’s dementias
What are the common ADRs of cholinesterase inhibitors?
N/V/D
Anorexia
Can also cause incontinence, dizziness, and insomnia
What does vagotonic mean?
Causes bradycardia, heart block and syncope
What is donepezil indicated for?
Severe AD
What is rivastigmine indicated for?
PD
Which cholinesterase inhibitors are not metabolized via cyp450?
Rivastigmine
Which cholinesterase inhibitor must be renally adjusted?
Galantamine
What is memantine indicated for?
Moderate to severe AD; possibly effective for mild to moderate AD
What are common ADRs of memantine?
Dizziness
HA
Constipation
Somnolence
What is the brand name of the combination product donepezil/memantine?
Namzeric
How is namzeric available?
10/14 mg (for CrCl 5-29)
10/28 mg ER
What are therapeutic considerations for vascular disease?
BP control
Treatment of dyslipidemia, homocysteinemia, and hyoerglycemia
Low dose ASA
What class of medications should be offered to patients with mild to moderate AD and may be helpful for patients with severe AD?
ChEIs
Which class of medications should be considered for patients with mild to moderate dementia associated with PD?
ChEIs
Which class of medications should be considered for patients with dementia with Lewy Bodies?
ChEIs
Which class of medications may be considered in moderate and severe AD?
Memantine
What type of dementia does memantine have limited evidence for?
Vascular
When is combination therapy considered?
Moderate-severe dementia
Those who have not had great clinical benefit with monotherapy ChEI
Those who cannot tolerate ChEI
When is combination therapy in mild dementia considered?
Patients who choose to take the added risk of ADRs and take on the extra cost for the potential added benefit
What were the results of studies of ChEIs in VD?
Clinical benefit is uncertain
Why are ChEIs used in VD?
Due to the high association with AD diagnosis
What were the results of studies of memantine in VD?
Some benefit but few with short duration
What are the benefits of using ChEIs in Lewy Body dementia?
May represent 1st line therapy as cholinergic deficits occur in this condition as well
What does conflicting data show for the use of ChEIs in Lewy Body Disease?
Notes worsening cognitive function, REM sleep disorder, or Parkinsonism with these agents
What does conflicting data show for the use of memantine in Lewy Body Disease?
Note worsening of delusions and hallucinations
What is the cornerstone of dementia therapy in PD?
ChEIs
How can ChEIs be discontinued in PD?
Should be tapered off to avoid sudden cognitive and neuropsychiatric sx
