Mx of Mild-Mod dementia

Question 1

Rec re cognitive rehab

Answer 1

insufficient evidence

Question 2

Rec re excercise

Answer 2

good evidence

Question 3

memantine in mild Alz?

Answer 3

not recommended

Question 4

combining memantine with ACEI

Answer 4

rational, but no evidence

Question 5

NOT recommended in mild-mod Alz

Answer 5

Vit E
antioxidants
B vitamins and folate 9unless deficient)
NSAIDS
HMG-CA
HRT

insuff evidence:
ginko
androgens for men

Question 6

insuff evidence to recommend in mild-mod Alz

Answer 6

ginko
androgens for men
cognitive excercise
daycares, home visits, other programs
music, snoezelin, light, reminicenceeTx, validation Tx, aroma Tx, massage Tx (for BPSD)

Question 7

Tx of Depression in dementia

Answer 7

if not full MDE/not severe: behavioural

if full/severe depression or dysthymia or lability: SSRI with low antichol

Question 8

Tx of Sleep in dementia

Answer 8

behavioural 1st
Clonazepam if related to LBD/REM sleep DO
short trial of short to mid acting benzos and related drugs

Question 9

Tx of VH in LBD

Answer 9

1st ACEI
then qutiapine (RA after 3 m of stablity)

Question 10

BPSD in general?

Answer 10

ACEI and memantine can help 2006
insufficient evidence for or against CEI for BPSD (2012)
then depends on sx

Question 11

pharm Tx of vascular dementia

Answer 11

2006:
ACE-I: fair evidence for Donepezil
insuff for Galantamine or memantine
Fair for Galantamine for mixed Alz+ vascular
2012: insufficient evidence for CEI in pure vascular dementia