NS: Dementia

Question 1

There are a number of conditions that cause the symptoms of dementia, Alzheimer’s disease accounts for most cases; other common causes include what? (2)

Answer 1

1. Vascular dementia (due to cerebrovascular disease)

2. Dementia with Lewy bodies

Question 2

Acetylcholinesterase inhibitors are recommended for the treatment of cognitive symptoms of mild-to-moderate dementia due to Alzheimer’s disease. What are some examples? (3)

Answer 2

1. Donepezil
2. Galantamine
3. Rivastigmine

Question 3

What is a suitable alternative for patients with moderate Alzheimer’s disease when acetylcholinesterase inhibitors are contra-indicated or are not tolerated?

Answer 3

Memantine.

NMDA receptor antagonist.

Question 4

Memantine is the drug of choice for what?

Answer 4

Patients with severe Alzheimer’s disease.

Question 5

Antipsychotic drugs should not be prescribed to patients with mild-to-moderate non-cognitive symptoms due to Alzheimer’s disease. They can however be offered to patients whose symptoms are severe.

What is the risk in this?

Answer 5

Careful consideration should be given to the patient’s co-morbid conditions and the benefits and risks of treatment. The MHRA has reported (2009) a clear increased risk of stroke and a small increased risk of death when antipsychotic drugs are used in elderly patients with dementia.

Question 6

In patients with what type of dementia should careful monitoring for severe untoward reactions, such as neuroleptic sensitivity reactions, take place if an antipsychotic is added to treatment?

Answer 6

Treatment with antipsychotic drugs should be started with a low dose and titrated upwards, with regular review. In patients who have dementia with Lewy bodies, careful monitoring for severe untoward reactions, such as neuroleptic sensitivity reactions, is recommended.

Question 7

Acetylcholinesterase inhibitors are not recommended in the treatment of what dementia?

Answer 7

Acetylcholinesterase inhibitors are not recommended in patients with vascular dementia.

Question 8

In the management of voilence, aggression, and extreme agitation in dementia, if intramuscular administration is needed, what are the options?

Answer 8

Lorazepam or haloperidol or olanzapine.

Question 9

Which drugs are not recommended for the management of voilence, aggression, and extreme agitation in dementia?

Answer 9

Diazepam and chlorpromazine.