Dementia vicki lean Flashcards
What is dementia
Dementia is a clinical syndrome of deterioration in mental function which interferes with activities of daily living (ADLs).
What are the signs and symptoms of Dementia
Memory loss
Language and communication difficulties
Visuoperceptual difficulties
Hallucinations
What are the different types of dementia
Alzheimer’s (50-75%)
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia
What causes dementia
Build up of plaque and tangles lead to nerve cell death and loss of brain tissue
What is the cause of Vascular dementia
Reduced blood flow to the brain due stroke, subcortical dementia, single and multi-infract dementia
What are Lewy-bodies
Tiny deposits of Alpha-synuclein that appear in nerve cells
What the risk factors of dementia
Age
Learning difficulties
Genetics
Cardiovascular diseases
Parkinson’s
Stroke
Depression
Heavy alcohol consumption
Low education attainment
Low social engagement and support
Mild cognitive impairment
What are the specific symptoms of the subtypes of dementia
Alzheimer’s Disease - Early impairment of episodic memory
Vascular Dementia - Stepwise increases in the severity of symptoms
Dementia with Lewy bodies - Repeated falls, syncope, transient loss of
consciousness and early and persistent visual hallucinations.
Frontotemporal Dementia - Personality change and behavioural disturbance
What are the steps to diagnosing Dementia (Ie in A a GP surgery)
Take History: Timescale, co-morbidities, Drugs, risk factors
Assess cognition
Assess daily function
Examine the person
Blood tests
What service are Pts with suspected dementia or mild cognition impairment referred to
Memory Assessment Service
What non-pharmacological treatment should NOT be offered to treat dementia
Acupuncture
Ginseng
Vit E
Herbal formulation
What non-pharmacological treatment should be offered to treat dementia
Group cognitive stimulation therapy for mild to moderate
Group reminiscence therapy
Cognitive rehabilitation or occupational therapy
What drug is first line for the treatment of Mild to moderate dementia
AChE inhibitor- Donepezil, Galatamine, Rivastigmine
What is used when Pts have Modertate AD and are CI to the others or Have Severe AD
Memantine (NMDA antagonist)
Mechanism of Memantine
Memantine acts as a competitive ‘NMDA antagonist’ thus reducing Ca2+entry into the cells
What are some the behavioural and psychological symptoms of dementia
Agitation, aggression, hoarding, wandering, hallucinations, sexual disinhibition, delusions, apathy and shouting
What are some of the first-line non-pharmacological intervention
Music therapy,
aromatherapy,
physical exercise
therapeutic touch
social interaction
What is last resort for the non-cognitive symptoms
Pharmacological interventions
In what circumstances are anti-psychotics given to dementia pts
‘risk of harming themselves or others
or are
experiencing agitation, hallucinations or delusions that are causing them severe distress
Which anti-psychotic is given to dementia patients
risperidone at the lowest effective dose for the shortest time period.
How often is the use of antipsychotic reviewd
At least every 6 weeks
What is the role of the Pharmacy team
Prescribing
Clinical interventions
Counselling
Supporting carers
Signposting
What do clinical check entail
Is the drug appropriate for the patient (co-morbidities)
Drug interactions
Renal & hepatic function (ability to metabolise)
Adherence-compliance aid
Appropriate formulation/ any swallowing difficulties?
Counselling point (such as side effect profile/ red flags
