Dementia vicki lean

Question 1

What is dementia

Answer 1

Dementia is a clinical syndrome of deterioration in mental function which interferes with activities of daily living (ADLs).

Question 2

What are the signs and symptoms of Dementia

Answer 2

Memory loss

Language and communication difficulties

Visuoperceptual difficulties

Hallucinations

Question 3

What are the different types of dementia

Answer 3

Alzheimer’s (50-75%)

Vascular dementia

Dementia with Lewy bodies

Frontotemporal dementia

Question 4

What causes dementia

Answer 4

Build up of plaque and tangles lead to nerve cell death and loss of brain tissue

Question 5

What is the cause of Vascular dementia

Answer 5

Reduced blood flow to the brain due stroke, subcortical dementia, single and multi-infract dementia

Question 6

What are Lewy-bodies

Answer 6

Tiny deposits of Alpha-synuclein that appear in nerve cells

Question 7

What the risk factors of dementia

Answer 7

Age
Learning difficulties
Genetics
Cardiovascular diseases
Parkinson’s
Stroke
Depression
Heavy alcohol consumption
Low education attainment
Low social engagement and support
Mild cognitive impairment

Question 8

What are the specific symptoms of the subtypes of dementia

Answer 8

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

Question 9

What are the steps to diagnosing Dementia (Ie in A a GP surgery)

Answer 9

Take History: Timescale, co-morbidities, Drugs, risk factors
Assess cognition
Assess daily function
Examine the person
Blood tests

Question 10

What service are Pts with suspected dementia or mild cognition impairment referred to

Answer 10

Memory Assessment Service

Question 11

What non-pharmacological treatment should NOT be offered to treat dementia

Answer 11

Acupuncture

Ginseng

Vit E

Herbal formulation

Question 12

What non-pharmacological treatment should be offered to treat dementia

Answer 12

Group cognitive stimulation therapy for mild to moderate

Group reminiscence therapy

Cognitive rehabilitation or occupational therapy

Question 13

What drug is first line for the treatment of Mild to moderate dementia

Answer 13

AChE inhibitor- Donepezil, Galatamine, Rivastigmine

Question 14

What is used when Pts have Modertate AD and are CI to the others or Have Severe AD

Answer 14

Memantine (NMDA antagonist)

Question 15

Mechanism of Memantine

Answer 15

Memantine acts as a competitive ‘NMDA antagonist’ thus reducing Ca2+entry into the cells

Question 16

What are some the behavioural and psychological symptoms of dementia

Answer 16

Agitation, aggression, hoarding, wandering, hallucinations, sexual disinhibition, delusions, apathy and shouting

Question 17

What are some of the first-line non-pharmacological intervention

Answer 17

Music therapy,

aromatherapy,

physical exercise

therapeutic touch

social interaction

Question 18

What is last resort for the non-cognitive symptoms

Answer 18

Pharmacological interventions

Question 19

In what circumstances are anti-psychotics given to dementia pts

Answer 19

‘risk of harming themselves or others

or are

experiencing agitation, hallucinations or delusions that are causing them severe distress

Question 20

Which anti-psychotic is given to dementia patients

Answer 20

risperidone at the lowest effective dose for the shortest time period.

Question 21

How often is the use of antipsychotic reviewd

Answer 21

At least every 6 weeks

Question 22

What is the role of the Pharmacy team

Answer 22

Prescribing

Clinical interventions

Counselling

Supporting carers

Signposting

Question 23

What do clinical check entail

Answer 23

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