Dementia Treatments Flashcards
At this point, is most treatment for AD pharmacological or non-pharmacological?
non
What is the mainstay for pharmacologic dementia treatment?
cholinesterase inhibitors
What ar ethe 4 cholinesterase inhibitors approved for AD?
donepezil (aricept), galantamine, rivastigmine, tacrine
Although tacrine was the first cholinesterase inhibitor used, we don’t use it anymore because…
it has an issue with hepatotoxicity
What is the most commonly use anticholinesterase? Why?
Donepezil (aricept) because it only has ot be dosed once a day and because it’s th eonly one that’s gone generic thus far, so its most affordable
How is rivastigmine administered differently than the others?
It had a slightly worse GI side effect profile, so they made it into a patch to avoid this
Although the most comon side effect of the anticholinesterase drugs is GI upset, what’s the rare side effect to watch out for?
some elderly dementia patients will dveelop manic episodes ont he drug
What’s basically the only form of dementia that the anticholinesterases don’t help?
frontotemporal dementia
What the mechanis of aciton for memantine (namenda)?
it’s an NMDA receptor agonist that attempts to slow programmed cell death due to excitotoxicity
Does Mementine improve cognition or slow decline?
slows decline
Why do you want to be cautious when prescribing memantine for lewy body dementia?
it can worsen delusions and hallucinations
What’s the main side effect of memantine?
dizziness
Can memantine be taken in conjunction with the cholinesterase inhibitors
Yes - and it should be
A lot of dementia treatment revolves around symptom management. What’s hte best way to handle depression in dementia?
SSRIs or SNRIs
avoid the tricyclics because they have anticholinergic properties and that would defeat the purpose
Atypical antipsychotics have been used for agitation, delusiosn and hallucinations in dementia. Which is the most common one used? Why be cautious?
Quetiapine (seroquel)
be catious because there seems to ba an increased risk of mortality with the antipsychotics in the elderly
Dementia often involves sleep disturbances where the circadian rhythm gets switched. What’s the best way to handle this?
do behavioral modification first - make sure they’re stimulated enough during the day so they sleep at night
you can use trazodone or melatonin, but definitely avoid OTC sleep meds bc they contain antihistamines, which has anticholinergic effects
True or false: exercise doesnt make much of a difference if someone already has dementia
false - it slows decline even in severe dementia
best if you start early though
Besides physical education, what environmental things can improve prognosis?
mental stimulation and social support
How can you prevent vascular dementia?
basically aggresssive treatment of risk factors for CVA -stop smoking, manage HTN, diabetes, cholesterol, etc.
What is the likely reason that the anticholinesterases help with vascular dementia?
because a combo of vascular dementia and alzheimer’s dementia is suuuper common
Are the cholinergic effects greater in LBD or AD?
LBD actually - you can stop the hallucinations in some patients
What should you never give to a LBD patient that you might to an AD patient?
an antipsychotic
LBD patients are very sensitive to them and can develop neuroleptic malignant syndrome and rapidly worsen
Will Parkinson’s meds help with lewy body dementia?
Yes - just start slowly because patients with LBD and not parkinsons tend to be more susceptible to the side effects
What can you give to lew body dementia patients for REM sleep imprivement?
clonazepam
