Geriatric Medicine

Question 1

Contraindication for donepezil in patient’s with Alzheimer’s?

Answer 1

Donepezil is generally avoided (relative contraindication) in patients with bradycardia and is used with caution in other cardiac abnormalities.

Galantamine is another acetylcholine esterase inhibitor like donepezil. Like donepezil, it can cause bradycardia but also atrioventricular block, and so is contraindicated in those with resting bradycardia and 1st-degree heart block.

Question 2

Pharmacological drug of choice in patients with parkinsons who are delirious and require sedation?

Answer 2

Quetiapine is a suitable choice to aid in the management of delirium in patients with Parkinson’s disease.

Haloperidol can worsen Parkinson symptoms.

Question 3

Features of Lewy Body Dementia?

Answer 3

1. Progressive cognitive impairment
   - typically occurs before parkinsonism, but usually both features occur within a year of each other. This is in contrast to Parkinson’s disease, where the motor symptoms typically present at least one year before cognitive symptoms
   -Cognition may be fluctuating, in contrast to other forms of dementia
   - In contrast to Alzheimer’s, early impairments in attention and executive function rather than just memory loss
2. Parkinsonism
3. Visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)