Neurocognitive Disorders (Dementia)

Question 1

Mild vs Major Neurocognitive Disorders

Answer 1

Basically, minor if it does not interfere with IADLs, major if it does.

Question 2

Main drugs used to treat the cognitive components of dementia

Answer 2

• Centrally-acting acetylcholinesterase inhibitors (ie, not neostigmine):
  
  • Donepezil
  • Galantamine
  • Rivastigmine
• NDMA receptor antagonists
  
  • Memantine

Question 3

If you have to use an antipsychotic to control agitation in a patient with Lewy Body Dementia, which should you be using?

Answer 3

Quetiapine

Fewest EPS effects in this population

Question 4

Paradoxical disinhibition

Answer 4

Refers to benzodiazepines paradoxically causing activation and agitation, characterized by:

AMS, anxiety, vivid dreams, hyperactivity, dexual disinhibition, hostility, and rage.

This occurs in a minority of patients on benzodiazepines and is a contraindication to further benzodiazepine usage. Dementia and old age are risk factors.

Question 5

Reasons to avoid benzodiazepines in the elderly

Answer 5

• Oversedation
• Unsteadiness and falls
• Paradoxical disinhibition