Witches and Wizards: Agitation in Dementia Flashcards
anx
rangews from worry and being nervus to fear and being scaed
apathy
laack of interest or emotion
agitiation
observable, nonspecific, restless behaviros that are excessive, inapprorpaite, adn repitive
aggression
involves physiclaly or verbally threatening behaiors direted at people, obejcts, or self
halluiations
perceptions (e.g. visual, auditory, tactile, olfactory, gustaory) w/o stimuli
delusons
fixed, idoisycratic or false perceptions or beliefs with little if any bass in reality and are not the result of religous or cultural norms
disinhibition
loss of inhibition, a lack of restraint, disregard for social convention, impulsiness, poor safety awareness, an inability to stop strong responses, desires, or emotions
treatment of NPS in dementia
- prescribing of psych meds last try all posible non-pharm (and even deprescribing) first
- symptom guided prescribing
mild NPS s/s
- depression
- anx
- irritblity
- apathy
severe NPS s/s
- agitaiton
- aggression
- vocalizations
- hallucinations
- delusions
- disinihbition
causes of NPS in dementia pts
- meds
- infection
- CVA
- trauma
- pain
environmental intervention for NPS tretent: educatio of family and caregivers
- scheduled toileting (pts don’t respond to urge to pee)
- offer graded assistance (as little help as possible)
- role modeling
- cueing
- positive reinforment
- avoid adversaral debates, redirect conversation isntead
- maintain calm demeaner
- caregiver support groups (alzheimer’s assocaition)
environmental intervention for NPS tretent: structruing phsycial and psychosocial environment
- music
- walking/light exercise
- simulate family presece with video or audio tapes
- pet therapy
- speak at pt comprehesion level
- white noise
- bright light
treatemnt of apathy
- methylphenidate
- dextroamphetamine
- modafanil
mood stabilizers in dementia with manic-like featurews
- CBZ
- lamotrigine
- Li
- VPA - preferred dt sprinkle cap (ease of admin) and better tolerability
treatment of sundowning
- ACUTE: trazadone first, then quetiapine
- do NOT use queitapine for insomnia, use it for sundowning which has behavioral aspects
- LONG TERM: trazadone or melatonin, quetiapine if those don’t work
treatment of insomnia in dementia
- sleep hygeine
- acute: trazodone, melatonin, mirtazapine; short term BZD if htose fail
- long term: trazodone, melatoin
treatment of agitiaton in dementia
brexpiprazole (given scheduled, not prn)
BBW of death still exists
treatment of agitiaton in context of psychosis in dementia
second gen antipsychotics
aripiprazole, olanzapine, quetiapine, risperidone
treatment of agitiaton in context of depression in dementia
SSRI
brexpipirzole ADR
- HA
- dizziness
- UTI
- nasopharyngitis
- sleep disturbances
the risks of antipsychotics in dementia pts are highest when?
early on in treatment
which antipsychotics are safer in demenita pts
- quetiapine
- brexiprazole (im assuming here)
____% of alz pts have psychotic symptoms
20%, most alz pts are ‘pleasantly confused’
psychotic symptos include delusions and hallucinations
parkinson’s hallucination treatment vs lewy body dementia hallucinatoin treatment
- parkinson’s: quetiapine
- lewy body: no APS
- parkinson’s doesn’t have cognitive deline
- lewy body dementia: cogitive delcine accompanied by motor features of parkinson’s
____% of alz pts have symptoms of agitaion or aggression
up to 80%
treatment of anx, mild to moderate irritabilty
- trazadone
- buspar - doesnt work as welel in pts who have been on benzos
treatment of agitiaton or aggressi ounresponsive to first line treatment
- VPA
- CBZ
- olanzapiine IM
treatment of sexual agression, impulse control in men
- second gen antipsychotic or VPA
- if no response estrogen OR medroxyprogesterone IM
insomnia vs sundowning
sundowning is incomnia with: pacing, wandering, yelling, combativeness
other s/s include:
- forgetful
- confused
- delirious
- agitated
- anx
- restless
