IC17 - Dementia

Question 1

Describe the clinical definition of significant dementia.

Answer 1

Evidence of significant decline cognitive decline and substantial impairment in cognitive performance by neuropsychological testing

Question 2

Describe the clinical definition of minor dementia.

Answer 2

Evidence of mild decline cognitive decline and modest impairment in cognitive performance by neuropsychological testing

Question 3

What are the non-modifiable risk factors?

Answer 3

Age, Female, Ethnicity (Black, Hispanic), Genes (Apolipoprotein E, APOE4)

Question 4

List 5 modifiable risk factors.

Answer 4

1. HTN
2. Diabetes
3. Smoking
4. Limited physical activities
5. Obesity

Question 5

What is the pathologic characteristics of Alzheimer dementia?

Answer 5

1. Brain atrophy especially mesial temporal lobe
2. Neuritic plaques containing β-amyloid and neurofibrillary tangles containing phosphorylated tau

Question 6

What are the two medications that can be used for Alzheimer dementia?

Answer 6

1. Anticholinesterase Inhibitors
2. NMDA receptor antagonist

Question 7

How does anticholinesterase inhibitors work for Alzheimer dementia?

Answer 7

Inhibit acetylcholinesterase enzyme > increases in acetylcholine > increase cholinergic neurotransmission

Question 8

What is the titration dosing regimen for anticholinesterase inhibitors like?

Answer 8

4 to 8 weeks

Question 9

How does memantine work for Alzheimer dementia?

Answer 9

Uncompetitive antagonist of NMDA type glutamate receptors > decrease excitotoxicity and neuronal cell death

Question 10

What monitoring should be done for Anticholinesterase inhibitors and memantine?

Answer 10

1. Caregiver feedback (improvement in day-to-day life activities)
2. Routine cognitive test

Question 11

When should acetylcholinesterase inhibitors be used for dementia patients?

Answer 11

Mild to moderate stage

Question 12

When should memantine be given for dementia patients?

Answer 12

1. Moderate to severe stage
2. Cannot tolerate AChE

Question 13

What is the management for dementia patients who are already taking AChE but require additional medication?

Answer 13

1. Consider Memantine for Mod
2. Offer for Memantine for severe

Question 14

What are some common adverse effects of AChE?

Answer 14

1. N/V
2. Increased frequency of bowel movements

Question 15

Who should use AChE with caution?

Answer 15

1. Peptic Ulcer
2. Seizure
3. Respiratory disease
4. Urinary tract obstruction

Question 16

Who cannot use AChE for dementia?

Answer 16

bradycardia patients

Question 17

Define BPSD.

Answer 17

Non-cognitive and non-neurological symptoms of dementia such as agitation, aggression, psychosis, depression and apathy

Question 18

How can patients with BPSD be managed?

Answer 18

1. Examine and treat underlying issues (physical problem, activity-related, intrinsic to dementia)
2. Offer medications like SSRI/ mirtazapine for depression, SSRI for anxiety, short acting hypnotic or melatonin for insomnia.

Question 19

How can patients with no BPSD be managed?

Answer 19

1. Check for delirium
2. If yes, treat underlying acute problem
3. If behavioural issues still exist, consider non-pharm approaches and pharm treatment only if BPSD is severe/ pose risk to others

Question 20

What are the pharmacological options for BPSD?

Answer 20

1. AChE (Donepezil)
2. Memantine
3. Trazodone
4. SSRIs
5. Lorazepam
6. Antipsychotic (Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride, Clozapine)

Question 21

When should medications for BPSD be withdrawn?

Answer 21

3 months of improved symptoms

Question 22

How is SSRI helpful in treatment of BPSD for dementia patients?

Answer 22

1. Treat depression and anxiety that cannot be managed by non-pharmacological interventions
2. Citalopram (reduce agitations)

Question 23

When should antipsychotics be initiated in patients with dementia?

Answer 23

1. Aggression, agitation, or psychotic symptoms are cuasing severe distress or an immediate risk of harm to patient or others

Question 24

Antipsychotics medications are associated with increased risk of ______, _____, _____ in older patients.

Answer 24

1. Stroke
2. CVS events
3. Mortality