4. Dementia Flashcards
(18 cards)
Alzheimer’s
What is it
Alzheimer’s disease destroys nerve connections in the brain,
making it progressively more difficult to do ordinary things like move around, swallow and feed yourself.
While the disease devastates the brain, it does not kill you.
Complications of the decline in brain function is what leads to death
Dementia
What is it
Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.
Alzheimer’s is the most common cause of dementia.
60-80%
Dementia
Symptoms
Cognitive 4
&
non-cognitive 2
Cognitive: 4
Memory loss (difficulty remembering)
Difficulty thinking (lack of concentration)
Language ( can’t find the word)
Orientation (dates, days, where is home)
Non-cognitive 2
Difficulty with daily activities
Psychiatric and behaviour problems (aggression)
Dementia
types 5
Alzheimer’s disease. Alzheimer’s disease is the most common cause of dementia
Vascular dementia
Lewy body dementia
Frontotemporal dementia 45-65 age or younger
Mixed dementia
Dementia usually starts from 60+
Vascular dementia
Drug Tx
Drug Tx is NOT recommended
Tx in
Mild- moderate
Alzheimer’s
List drugs
Acetylcholinesterase inhibitors
donepezil
rivastigmine
galantamine
Acetylcholinesterase inhibitors
SE
(DUMB BELS)
DUMB BELS
diarrhoea
Urination ⬆️
Muscle weakness/cramps
Bronchospasm (SOB)
Bradycardia
Emesis (vomit)
Lacrimation (teary eyes)
Salivation/sweating
Anxiety; appetite decreased; arrhythmias; asthenia; dehydration; depression; diarrhoea; dizziness; drowsiness; fall; gastrointestinal discomfort; headache; hyperhidrosis; hypersalivation; hypertension; movement disorders; nausea; skin reactions; syncope; tremor; urinary incontinence; urinary tract infection; vomiting; weight decreased
Acetylcholinesterase inhibitors
List with 1 common SE
Donepezil
Galantamine
Rivastigmine
Which Drug (especially with concomitant antipsychotics)
causes this SE
Neuroleptic malignant syndrome
Donepezil
Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic drugs
characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction.
Which Drug
causes this SE
Skin rash
(Stevens-Johnson syndrome rash)
STOP IMMEDIATELY
Galantamine
The syndrome often begins with flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off.
Stevens-Johnson syndrome is a medical emergency that requires treatment in hospital, often in intensive care or a burns unit.
Rivastigmine
The main reason from changing oral to patch is which SE?
GI disturbances
stop meds till problem resolved
Moderate - severe Alzheimer’s
Acetylcholinesterase inhibitors are
CI
What is the Tx
Memantine
If acetylcholinesterase inhibitors CI in patient with moderate Alzheimer’s give:
Memantine
What is
Oscillopsia
Oscillopsia is the sensation that the surrounding environment is constantly in motion when it is, in fact, stationary. Oscillopsia is usually a symptom of conditions that affect eye movement or the eye’s ability to stabilize images, especially during movement
Managment of
SEVERE
non-cognitive symptoms
In dementia (non-Lewy body)
(Psychic and behaviour problems )
Oral
Benzodiazepines
Or
antipsychotic
(If IM needed: haloperidol, olanzapine, lorazepam)
IV route only in EXCEPTIONAL circumstances
Managment of
SEVERE
non-cognitive symptoms
(Psychic and behaviour problems )
In Lewy body dementia associated with parkingsons disease
Acetylcholinesterate inhibitors
Rivastigmine
(Also used to treat cognitive symptoms)
As this is the ONLY acetylcholinesterate licensed in dementia with Parkingsons
When to treat
Severe non-cognitive symptoms in dementia
Only in SEVERE that cause SIGNIFICANT DISTRESS or IMMEDIATE risk of harm to self or others
MHRA ⚠️ Increased risk of: Stroke And Death
In elderly pts
Assess benefit over risk & history of CVD
this is the ONLY acetylcholinesterate inhibitor
licensed in dementia with Parkingsons
Rivastigmine
