Drugs for Dementia

Question 1

What is the MOA of donepezil?

Answer 1

• Inhibits centrally active acetylcholine-esterase

Question 2

What are the clinical application of donepezil?

Answer 2

• Mild to moderate Alzheimer disease –> 30-50% do not have a response and around 20% have a larger than normal response

Question 3

What are some toxicities of donepezil?

Answer 3

• Altered cardiac conduction
• N/V/D
• Caution with it since it can worse peptic ulcer, asthma/COPD, bladder outflow obstruction

Question 4

What can happen if there is abrupt discontinuation of donepezil?

Answer 4

• Rapidly changing mood
• Crying easily
• Agitation
• Trouble sleeping
• Intense hallucinations
• Difficulty concentrating

Question 5

What is rivastigmine and galantamine?

Answer 5

• Rivastigmine –> similar to donepezil but is a 24 hr patch

- Galantamine –> reversible AChE inhibitor for dementia

Question 6

What is the MOA of memantine?

Answer 6

• NMDA receptor antagonist

Question 7

What are the clinical applications of memantine?

Answer 7

• Alzheimer disease, moderate to severe –> could be monotherapy or in combo with cholinesterase inhibitor

Question 8

What are some toxicities of memantine?

Answer 8

• Adverse effects tend to be small and lack clinical significance
• Confusion, dizziness, headache
• Rarely skin hypersensitivity reactions

Question 9

What should be avoided in memantine use? Why?

Answer 9

• Abrupt discontinuation which can cause altered mental status

Question 10

What is aducanumab?

Answer 10

• Monoclonal antibody directed against aggregated soluble and insoluble forms of amyloid beta

Question 11

What are the clinical applications of aducanumab?

Answer 11

• Alzheimer disease in patients with mild cognitive impairment of mild dementia stage of disease

Question 12

What are some toxicities of aducanumab?

Answer 12

• Amyloid related imaging abnormalities –> edema, hemosiderin deposition

Question 13

What are some clinical symptoms of aducanumab?

Answer 13

• Altered mental status
• Dizziness
• Headache
• Nausea
• Visual disturbances

Question 14

What are some other treatments for dementia that may have little to no evidence of benefit?

Answer 14

• Vitamin E
• Selegiline
• Estrogen
• NSAIDs
• Ginkgo biloba
• B vitamins
• Omega-3-fatty acids

Question 15

What is the first step in Alzheimer treatment?

Answer 15

• Begin treatment with acetylcholinesterase inhibitor –> if moderate or severe than able to add memantine
• Add memantine to mild disease treatment if patient is not tolerating medication or they continue to deteriorate

Question 16

What needs to be done when neuropsychiatric symptoms appear?

Answer 16

• Identify precipitating factors

- Rule out and treat medical cause or superimposed delirium