Essential Tremor & Dementia/Alzheimer’s Disease

Question 1

What are the recommended pharmacological treatments for essential tremor?

Answer 1

Beta blockers

Anticonvulsants (i.e., primidone)

Question 2

Name cardiovascular differential diagnosis/es for dementia and describe the signs and symptoms.

Answer 2

DDs:
- vascular dementia
- multi-infarct dementia

S/S:
- acute or slow decline in cognition

Question 3

Name delirium differential diagnosis/es for dementia and describe the signs and symptoms.

Answer 3

DDs:
- Hyponatremia
- Hypoxia
- Medications (I.e., benzos, cholinergics)

S/S:
- acute change in cognition

Question 4

Name the signs and symptoms common to both depression and dementia.

Answer 4

Complaints of memory loss and impaired concentration

Question 5

Name the medications recommended for early Alzheimer’s disease.

Answer 5

Cholinesterase inhibitors:
- donepezil
- rivastigmine
- galantamine

NMDA receptor agonist:
- Memantine

Question 6

Describe the potential benefits of cholinesterase inhibitors for Alzheimer’s.

Answer 6

May improve cognitive s/s:
- memory
- thinking
- language
- judgment

May improve ADLs

Small improvements in mild-moderate disease

Question 7

Describe the potential benefits of memantine for Alzheimer’s.

Answer 7

May be neuroprotective

Improved cognition

Usually well tolerated

Question 8

What medications should be considered for advanced Alzheimer’s disease? List any associated potential risks.

Answer 8

Combination of:
- cholinesterase inhibitors and memantine

Olanzapine: 1st choice for advanced disease

Quetiapine: 2nd choice for advanced disease

Olanzapine and Quetiapine:
- may in crease mortality
- risk of side effects