Mx of severe Dementia

Question 1

Global Deterioration of functioning scales

Answer 1

1: no sx
2: subjective complaints
3: MCI, but IADLS preserved
4: IADLs
5:needs cuing for ADLs, forgets address
6: dependent for ADLs, forgets spouse’s name, incontinence
7: almost non verbal
cannot walk

6-7 is severe demntia

Question 2

Medications in severe Alz disease:

aggression

Answer 2

Risperdal 1 mg per day
Olanzapine 5-10 mg per day 
Abilify (2012)
grade A evidence
=OAR, also for psychosis

Ativan PRN. grade B

insufficient evidence for or against:
Trazodone (but mentioned as an option in text)
SSRI (but mentioned as an option in the text)
Seroquel
CEI
Memantine

Do not use epival

insufficient evidence for or against CEI for BPSD

Question 3

Medications in severe Alz disease:

behavioural management?

Answer 3

behavioural mx of sx
education of caregivers on ABC
music and snoezelen effective during session but insufficient evidence for LT effect

Question 4

Medications in severe Alz disease: SSRI, ACE, memantine

Answer 4

yes. SSRIs for severe depression

can give either ACE-I or memantine or both