Progressive Cog Disorders Trx

Question 1

What meds are used for anti-dementia therapy?

Answer 1

1. Cholinesterase inhibitors → slow progression and increase function in AD, DLD, and vascular dementia
2. Namenda/Memantine → manage compulsive behaviors in FTLD and AD
3. SSRIs → mood stabilizer, antipsychotics for behavioral symptoms and depression in FTLD and vascular dementia
4. Currently no FDA approved med for agitation or psychosis seen in dementia

Question 2

Outcome measures for Dementia can be divided into what 2 categories?

Answer 2

1. Cognitive
2. Physical

Question 3

Cognitive outcome measures for dementia can be further divided into what 2 categories?

Answer 3

1. global functioning
2. executive functioning

Question 4

list some global functioning cognitive outcome measures for dementia

Answer 4

1. MMSE
2. AD activity scale-cog
3. severe impairment battery
4. MOCA

Question 5

list some executive functioning cog outcome measures for dementia

Answer 5

1. verbal fluency test-category
2. verbal fluency test-letters
3. clock drawing test

Question 6

describe the MMSE

Answer 6

Mini-Mental State Examination

1. brief screening tool, provides quantitative assessment of cog impairments
2. 11 simple questions, 7 domains
   
   • total of 30 points
   • orientation to time
   • orientation to place
   • registration of 3 words
   • attention and calcuation
   • recall of 3 words
   • language
   • visual construction

Question 7

describe cut-off scores for the MMSE

Answer 7

• >/= 24 → no cog impairment
• 18-24 → mild cog impairment
• 0-17 → severe cog impairment

Question 8

List some treatment considerations for dementia patients

Answer 8

1. progressively lowered stress threshold theory
2. fatigue
3. engagement
4. communication

Question 9

what is included in the progressively lowered stress threshold theory?

Answer 9

1. people w/dementia prefer to lead a lifestyle as close as possible to what they have lived across the lifespan
2. person with dementia will become progressively disabled in coping w/stress
3. people experiencing secondary behavioral symptoms are uncomfortable
4. secondary behavioral symptoms occur when stress exceeds the person’s capacity: like panic attacks
5. people experiencing secondary behavioral anxiety and often tries to relieve stress prior to incident
6. factors triggering these episodes can be controlled or modified to prevent excess disability and can occur up to 36 hrs prior to the stress-related event

Question 10

what should be considered in regards to fatigue in dementia patients?

Answer 10

1. often primary factor contributing to behavioral changes
   
   • decreased capacity to deal with change
2. treatment strategies:
   
   • frequent cog and motor rest breaks
   • strategic scheduling
   • establishing routines
   • consider environment

Question 11

what should be considered in regards to engagement in dementia pts?

Answer 11

1. find activities and create environment that creates meaningful experiences for your pts
2. max success through adaptations and supportive cues
3. familiar activities often elicit more + responses than new or unfamiliar ones
4. use family to your benefit as able

Question 12

what should you consider in regards to communication with dementia pts?

Answer 12

1. these pts have poor immediate and short-term memory, rep, understanding, and issues with ID of words and name
2. language is often vague and tangential
3. Try to avoid:
   
   • arguing, reasoning, over-explaining, or coercing when pt has inappropriate or incorrect thought
   • make pt feel guilty for not remembering
   • pre-announce plans
4. Enter their reality