Dementia Treatments

Question 1

At this point, is most treatment for AD pharmacological or non-pharmacological?

Answer 1

non

Question 2

What is the mainstay for pharmacologic dementia treatment?

Answer 2

cholinesterase inhibitors

Question 3

What ar ethe 4 cholinesterase inhibitors approved for AD?

Answer 3

donepezil (aricept), galantamine, rivastigmine, tacrine

Question 4

Although tacrine was the first cholinesterase inhibitor used, we don’t use it anymore because…

Answer 4

it has an issue with hepatotoxicity

Question 5

What is the most commonly use anticholinesterase? Why?

Answer 5

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

Question 6

How is rivastigmine administered differently than the others?

Answer 6

It had a slightly worse GI side effect profile, so they made it into a patch to avoid this

Question 7

Although the most comon side effect of the anticholinesterase drugs is GI upset, what’s the rare side effect to watch out for?

Answer 7

some elderly dementia patients will dveelop manic episodes ont he drug

Question 8

What’s basically the only form of dementia that the anticholinesterases don’t help?

Answer 8

frontotemporal dementia

Question 9

What the mechanis of aciton for memantine (namenda)?

Answer 9

it’s an NMDA receptor agonist that attempts to slow programmed cell death due to excitotoxicity

Question 10

Does Mementine improve cognition or slow decline?

Answer 10

slows decline

Question 11

Why do you want to be cautious when prescribing memantine for lewy body dementia?

Answer 11

it can worsen delusions and hallucinations

Question 12

What’s the main side effect of memantine?

Answer 12

dizziness

Question 13

Can memantine be taken in conjunction with the cholinesterase inhibitors

Answer 13

Yes - and it should be

Question 14

A lot of dementia treatment revolves around symptom management. What’s hte best way to handle depression in dementia?

Answer 14

SSRIs or SNRIs

avoid the tricyclics because they have anticholinergic properties and that would defeat the purpose

Question 15

Atypical antipsychotics have been used for agitation, delusiosn and hallucinations in dementia. Which is the most common one used? Why be cautious?

Answer 15

Quetiapine (seroquel)

be catious because there seems to ba an increased risk of mortality with the antipsychotics in the elderly

Question 16

Dementia often involves sleep disturbances where the circadian rhythm gets switched. What’s the best way to handle this?

Answer 16

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

Question 17

True or false: exercise doesnt make much of a difference if someone already has dementia

Answer 17

false - it slows decline even in severe dementia

best if you start early though

Question 18

Besides physical education, what environmental things can improve prognosis?

Answer 18

mental stimulation and social support

Question 19

How can you prevent vascular dementia?

Answer 19

basically aggresssive treatment of risk factors for CVA -stop smoking, manage HTN, diabetes, cholesterol, etc.

Question 20

What is the likely reason that the anticholinesterases help with vascular dementia?

Answer 20

because a combo of vascular dementia and alzheimer’s dementia is suuuper common

Question 21

Are the cholinergic effects greater in LBD or AD?

Answer 21

LBD actually - you can stop the hallucinations in some patients

Question 22

What should you never give to a LBD patient that you might to an AD patient?

Answer 22

an antipsychotic

LBD patients are very sensitive to them and can develop neuroleptic malignant syndrome and rapidly worsen

Question 23

Will Parkinson’s meds help with lewy body dementia?

Answer 23

Yes - just start slowly because patients with LBD and not parkinsons tend to be more susceptible to the side effects

Question 24

What can you give to lew body dementia patients for REM sleep imprivement?

Answer 24

clonazepam

Question 25

Although the cholinesterase inhibitors and memantine don’t do much for frontotemporal dementia, what can we give?

Answer 25

SSRIs to help with behaviors

atypical antipsychotics to help with agitation

stimulants to increase activity in frontal lobes