Nervous System

Question 1

What are symptoms of Dementia?

Answer 1

• memory loss,
• problems with reasoning and communication,
• a change in personality
• reduced ability to carry out daily activities such as washing or dressing

Question 2

what are the types of dementia?

Answer 2

Alzheimer’s disease is the most common type of dementia;
- vascular dementia (due to cerebrovascular disease),
- dementia with Lewy bodies,
- mixed dementia
- frontotemporal dementia.

Question 3

what are the aims of dementia treatment?

Answer 3

promote independence, maintain function, and manage symptoms of dementia.

Question 4

What are the non-drug treatment available for dementia patients?

Answer 4

mild-to-moderate dementia presenting with cognitive symptoms. = Structured group cognitive stimulation programme.

Group reminiscence therapy and cognitive rehabilitation or occupational therapy to support daily functional ability, should also be considered

Question 5

What is the MHRA warning concerning antipsychotics

Answer 5

Increased risk of stroke and death in elderly with dementia.

Question 6

Why should some medicines be minimised in Dementia?

Answer 6

Most drugs increase anticholinergic burden and therefore cognitive impairment

Question 7

What medicines should be minimised in Dementia?

Answer 7

Drugs with antimuscarinic effects include 1. some antidepressants (e.g. amitriptyline hydrochloride, paroxetine),
2. antihistamines (e.g. chlorphenamine maleate, promethazine hydrochloride),
3. antipsychotics (e.g. olanzapine, quetiapine),
4. urinary antispasmodics (e.g. solifenacin succinate, tolterodine tartrate)

Question 8

What is the treatment of Dementia?

Answer 8

FIRST LINE: Acetylcholinesterase Inhibitor e.g. Galantamine, Rivastigmine and Donepezil

Severe Condition - Memantine

Question 9

How is agitation, aggression, distress and psychosis treated in dementia?

Answer 9

Antipsychotic drugs should be used at the lowest effective dose and for the shortest time possible, with a regular review at least every 6 weeks

Question 10

what is the MoA of Anticholinesterase inhibitors

Answer 10

Block anticholinesterase thus preventing the breakdown of acetylcholine`

Question 11

What is a serious side effect of Donepezil?

Answer 11

Neuroleptic Malignant Syndrome

Question 12

What is a serious side effect of Galantamine?

Answer 12

Serious Skin Reactions
Patient should STOP at first signs of rash

Question 13

What is a serious side effect of Rivastigmine

Answer 13

GI problems - Withhold Patch

Question 14

What are Cholinergic effects?

Answer 14

D - Diarrhoea
U - Urination
M - Muscle Weakness, Miosis (Small Pupils)
B - Bronchospasms
B - Bradycardia
E - Emesis (Vomiting)
L - Lacrimation (Tears)
S - Salivation

Question 15

What should be considered for patients with Dementia dealing with depression?

Answer 15

Psychological treatments such as CBT, animal assisted therapy.

Question 16

What can happen with the use of antipsychotics in certain types of dementia?

Answer 16

1. Dementia with Lewy bodies or Parkinson’s disease dementia, antipsychotic drugs can worsen the motor features of the condition.
2. severe antipsychotic sensitivity reactions in some cases.