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PR3153 > IC17 Dementia > Flashcards

IC17 Dementia Flashcards

1
Q

What are the 4 diagnostic criteria for major dementia?

A
  1. Significant cognitive decline
  2. Affects daily activities
  3. Not explained by other mental conditions
  4. Cognitive deficits do not occur in delirium
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2
Q

What are diagnostic criteria for minor dementia?

A
  1. Modest cognitive decline
  2. Affects daily activities
  3. Not explained by other mental conditions
  4. Cognitive deficits do not occur in delirium
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3
Q

There are different types of dementia. Alzheimer’s is one type of dementia.

What are the risk factors of Alzheimers?
- Non-modifiable
- Modifiable

A

Non-modifiable risk factors:
- Age
- Female
- Black & Hispanic
- Genetics

Modifiable risk factors:
- HTN
- DM
- Smoking
- Limited physical activities
- Obesity

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4
Q

What lab test should we conduct to rule out other conditions from dementia?

A
  1. Thyroid function test
  2. Vit B12 level
  3. CT scan or MRI of the brain
    - Alzheimer’s disease often show up as hippocampal atrophy
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5
Q

What assessment tools should we use to assess a pt for dementia?

A

There are 2 assessment tools we can use:

  1. Mini Mental State Examination (MMSE).
  2. Montreal Cognitive Assessment (MOCA)

The lower the score, the worse the severity of dementia for both assessment tool.

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6
Q

What is the pathophysiology of Alzheimer’s disease?

A

It is the accumulation of plaque and neurofibrillary tangle (NFT).

The accumulation of plaque and NFT leads to neurodegeneration of the brain.

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7
Q

What is the goal of therapy in treating Alzheimer’s disease?

A

To reduce suffering caused by cognitive & accompanying symptoms, while delaying progressive cognitive decline.

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8
Q

What are the pharmacological agents used in Alzheimer’s disease?

A
  1. Acetylcholinesterase inhibitors
  2. NMDA receptor antagonist
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9
Q

What is the MOA of acetylcholinesterase inhibitors?

A

To inhibit acetylcholinesterase enzyme.

This increases the amount of acetylcholine at the synaptic cleft for neuro transmission.

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10
Q

How are acetylcholinesterase inhibitors used in dementia pt?

A

They are used for mild to moderate Alzheimer’s disease.

Examples of acetylcholinesterase inhibitors inhibitors:
- Donepezil
- Galantamine
- Rivastigmine

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11
Q

What is the MOA of NMDA receptor antagonist?

E.g. of NMDA receptor antagonist - Memantine

A

Memantine is an non-competitive inhibitor of N-methyl-D-aspartate (NMDA) type of glutamate receptors.

Glutamate can contribute to the pathogenesis of Alzheimer’s disease via overstimulation of glutamate receptors, leading to excitotoxicity and neuronal cell death.

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12
Q

How is NMDA receptor antagonist, memantine, used in dementia pt?

A

Memantine is used for:

  1. Moderate to severe dementia
  2. Pt who cannot tolerate acetylcholinesterase inhibitors
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13
Q

Comparing AChE inhibitors with Memantine, what is the main difference in both?

A

AChE inhibitors are used for mild-moderate Alzheimer’s disease.

Memantine is used for moderate-severe Alzheimer’s disease OR pt intolerant to AChE inhibitors.

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14
Q

When initiating AChE inhibitors in pt with Alzheimer’s disease, there can be a few ADRs.

What are the common ADRs that pt will likely experience?

A
  1. N&V
  2. Loss of appetite
  3. Increased frequency of bowel movement
  4. Vivid dreams
  5. Insomnia
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15
Q

Which pts are CI with the use of AChE inhibitors?

A

Pts w bradycardia.

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16
Q

What are the common ADRs of memantine?

A
  1. Headache
  2. Hallucination
  3. Confusion
  4. Dizziness
  5. Constipation
17
Q

In terms of medications, what else can a pharmacist do for Alzheimer’s pt?

A
  1. Reduce polypharmacy
  2. Review medications that may contribute to cognitive impairment
  3. Help caregiver with medication management issues
18
Q

What are some non-pharmacological management for Alzheimer’s disease patient?

A
  1. Ensure pt is safe - inside & outside of their home
  2. Assist in long term health care planning - living arrangements for late stage dementia
  3. *Effective communication - using visual aids
19
Q

In dementia, there are S&S which are called:
- Behavioural & Psychological Symptoms of Dementia (BPSD)

What are some S&S of BPSD?

A

Depression, anxiety and insomnia can be among the first few symptoms of dementia.

Agitation and aggression are more common in later stages of dementia, esp when the pt’s ability to communicate & influence their environment diminishes.

20
Q

When a pt has dementia, we must differentiate dementia from delirium.

How can you differentiate the 2?

A

Dementia will present w BPSD symptoms - Depression, anxiety, insomnia.

Delirium pt do not present w BPSD. Instead they present w confusion, hallucination, delusion w fluctuating cognition.

If pt presents w delirium, treat the underlying medical problem that cause the delirium.

21
Q

What are pharmacotherapy treatments for BPSD pt?

A
  1. Acetycholinesterase (AChE) inhibitors
  2. Memantine
  3. Trazodone
  4. SSRIs
  5. Lorazepam
  6. Anti-psychotic for pt that cause severe distress or an immediate risk of harm to the ppl around- 1st line is Risperidone.
  7. Quetiapine - for pt w Parkinson’s disease
  8. Tricyclic antidepressants (TCAs)

Pharmacological therapy is often given as a trial to see if there is any response to treatment or ADR. Pt is to be checked every 3 months.

Medication to be slowly withdrawn after 3 months of improved symptoms.

22
Q

What is the risk of using antipsychotics in older patients?

A

The use of antipsychotic medications can cause:

  1. Increased risk of strokes
  2. Increased risk of CV events
  3. Excess mortality

in a short timeframe.

23
Q

What is the non-pharmacological approach to BPSD pt?

A
  1. Person centered approach
    - e.g knowing their life story, culture and etc.
24
Q

In this IC, we learned about a possible upcoming -mab that can be used to help reduce cognitive decline in Alzheimer’s Disease.

What is the name of the -mab?

A

Lecanemab

25
Q

What is the level of severity of Alzheimer’s Disease that Lecanemab is used in?

A

Lecanemab is used in pt with mild-moderate cases of Alzheimer’s Disease

PR3153 (18 decks)

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