Mental Health Update - Dementia

Question 1

Define dementia. (1)

Answer 1

Progressive clinical syndrome of deteriorating mental function significant enough to interfere with daily living activities.

Question 2

What are the 3 main types of Dementia? (3)

Answer 2

Alzheimer’s
Vascular
Lewy body

Question 3

What are the key features of Donepezil? (3)

Answer 3

Specialist initiation
5mg ON. Max 10mg ON
Bradycardia - review with BB and other drug that reduce HR.

Question 4

What are the key features of Galantamine? (4)

Answer 4

Initially 4mg BD
Maintenance 8-12mg BD
Bradycardia
Dose reduction in hepatic impairment
Rare SJS (skin reactions)

Question 5

What are the key features of Rivastigmine? (3)

Answer 5

Oral/topical (patch)
Daily application transdermal patches (4.6mg/24 hours), (9.5mg/24 hrs) and (13.3mg/24 hrs) NOT to be confused with twice weekly application transdermal patches which are available of 4.6mg/24 hrs and 9.5mg/24 hrs.

Question 6

What are the key features of Memantine? (3)

Answer 6

5mg OD. Max = 20mg
Dose reduction required with renal impairment (watch eGFR)
Reduce dose to 10mg daily (eGFR 30-49ml/min) If well tolerated after 7 days dose can be increased in steps to 20mg daily; reduce dose to 10mg daily if (eGFR 5-29ml/min)