IC17 - Dementia Flashcards
Describe the clinical definition of significant dementia.
Evidence of significant decline cognitive decline and substantial impairment in cognitive performance by neuropsychological testing
Describe the clinical definition of minor dementia.
Evidence of mild decline cognitive decline and modest impairment in cognitive performance by neuropsychological testing
What are the non-modifiable risk factors?
Age, Female, Ethnicity (Black, Hispanic), Genes (Apolipoprotein E, APOE4)
List 5 modifiable risk factors.
- HTN
- Diabetes
- Smoking
- Limited physical activities
- Obesity
What is the pathologic characteristics of Alzheimer dementia?
- Brain atrophy especially mesial temporal lobe
- Neuritic plaques containing β-amyloid and neurofibrillary tangles containing phosphorylated tau
What are the two medications that can be used for Alzheimer dementia?
- Anticholinesterase Inhibitors
- NMDA receptor antagonist
How does anticholinesterase inhibitors work for Alzheimer dementia?
Inhibit acetylcholinesterase enzyme > increases in acetylcholine > increase cholinergic neurotransmission
What is the titration dosing regimen for anticholinesterase inhibitors like?
4 to 8 weeks
How does memantine work for Alzheimer dementia?
Uncompetitive antagonist of NMDA type glutamate receptors > decrease excitotoxicity and neuronal cell death
What monitoring should be done for Anticholinesterase inhibitors and memantine?
- Caregiver feedback (improvement in day-to-day life activities)
- Routine cognitive test
When should acetylcholinesterase inhibitors be used for dementia patients?
Mild to moderate stage
When should memantine be given for dementia patients?
- Moderate to severe stage
- Cannot tolerate AChE
What is the management for dementia patients who are already taking AChE but require additional medication?
- Consider Memantine for Mod
- Offer for Memantine for severe
What are some common adverse effects of AChE?
- N/V
- Increased frequency of bowel movements
Who should use AChE with caution?
- Peptic Ulcer
- Seizure
- Respiratory disease
- Urinary tract obstruction
Who cannot use AChE for dementia?
bradycardia patients
Define BPSD.
Non-cognitive and non-neurological symptoms of dementia such as agitation, aggression, psychosis, depression and apathy
How can patients with BPSD be managed?
- Examine and treat underlying issues (physical problem, activity-related, intrinsic to dementia)
- Offer medications like SSRI/ mirtazapine for depression, SSRI for anxiety, short acting hypnotic or melatonin for insomnia.
How can patients with no BPSD be managed?
- Check for delirium
- If yes, treat underlying acute problem
- If behavioural issues still exist, consider non-pharm approaches and pharm treatment only if BPSD is severe/ pose risk to others
What are the pharmacological options for BPSD?
- AChE (Donepezil)
- Memantine
- Trazodone
- SSRIs
- Lorazepam
- Antipsychotic (Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride, Clozapine)
When should medications for BPSD be withdrawn?
3 months of improved symptoms
How is SSRI helpful in treatment of BPSD for dementia patients?
- Treat depression and anxiety that cannot be managed by non-pharmacological interventions
- Citalopram (reduce agitations)
When should antipsychotics be initiated in patients with dementia?
- Aggression, agitation, or psychotic symptoms are cuasing severe distress or an immediate risk of harm to patient or others
Antipsychotics medications are associated with increased risk of ______, _____, _____ in older patients.
- Stroke
- CVS events
- Mortality
