Alzheimer’s

Question 1

What is demintia?

Answer 1

• Cognitive decline (more severe tho)

Question 2

What are some of the signs and symptoms of dementia?

Answer 2

• Memory Loss
• Difficulty Planning things
• Getting Lost in familiar places
• Repeating words and information
• Difficulty finding the words
• Delusion and agitation

Question 3

What are some of the screening and diagnosis tools to help with seeing if a patient has dementia.

Answer 3

• Mini Mental State Exam (MMSE: max score 30), Montreal Cognitive Assessment (MoCA), DSM-5 Criteria
• Ruling out Vitamin D & B12 deficiency (
• Brain Imaging and looking at amyloid beta and tau levels

Question 4

What is important to know about anticholinergics & memory impairment?

Answer 4

• Drugs with HIGH antichoinergic potency can cause acute cognitive impairnment
• BEERS CRITERIA

Question 5

What are some of the drugs that can worsen dementia?

Answer 5

• Antipsychotics (Aripiprazole, Chlorpromazine)
• CNS Depressants (Barbiturates [Pehnobarbital], Benzos [Alprazolam, Clonazepam], Opioids [Hydrocodone, Morphine], Hypnotics [eszopicloine, zolpidem], Skeletal Muscle relaxants [carisoprodol])
• Drug with Antichlinergic Effects (Antiemetices [prochlorperazine], antihistamines [benadryl, doxylamine], Central anticholinergics [benztropine], Peripheral anticholinergics [oxybutynin, dicyclomine], TCAs [amitriptyline])

Question 6

what are some natural products that can help with dementia/

Answer 6

• Vitamin E (2000 units daily) can slow the rate of decline
• acetly-L-carnitine, Ginkgo, vinpocetine

Question 7

What are some Non-drug treatment options for someone with dementia?

Answer 7

• DC drugs that can worsen it
• Exercise
• Eat healthy
• Control Blood Glucose, Blood Pressure, Cholesterol
• Stimulate the brain with activities

Question 8

What are some of the drug treatment options for demenita/

Answer 8

• Acetylcholinesterase Inhibitors
• +/- Memantine
• +/- other agents to help with other problems (depression, agitation, Psychosis)

Question 9

What is the MOA for the acetylchoinesterase inhibitors use for dementia?

Answer 9

• inhibits centrally active acetylcholinesterase; stoping the breakdown of acetylcholine = increased acetylcholine

Question 10

What are the acetylcholinesterase inhibitors that are used for dementia?

Answer 10

• Donepezil (Aricept) + Memantine (Namzaric)
• Rivastigmine (Exelon)
• Galantamine and Benzgalatamine (new agent)

Question 11

What are some warnings for acetylcholinesterase Inhibitors used in dementia?

Answer 11

• Cardiac Effects –> Bradycardia
• Donepezil: QTc Prolongation
• GI issues –> Nausea, Vomiting, Diarrhea

Question 12

What are some side effects for acetylcholinesterase inhibitors used in dementia?

Answer 12

• Insomnia
• Dizziness

Question 13

What are some additional notes for acetylcholinesterase inhibitors used in dementia?

Answer 13

• Donepezil is QHS to reduce nausea; if insomnia occurs then do QAM
• Remove patch (Exelon) before MRIs (duh)
• If stable on donepezil 10mg, can switch to Namzaric

Question 14

What is the MOA for the N-Methyl-D-Aspartate (NMDA) Receptor Blocker?

Answer 14

• Prevents glutamate (excitatory neurotransmitter) from binding to he NMDA receptor preventing overstimulation and neuronal death

Question 15

What is the NMDA receptor blocker that is used for Dementia/

Answer 15

• Memantine (Namenda) + Donepezil (Namzaric)

Question 16

What are some side effects for Mematine used in dementia?

Answer 16

• Generally well tolerated BUT
• Dizziness, Confusion, Headache, Constipation

Question 17

What are some additional notes for Mementine used in dementia?

Answer 17

• ER Cap & Namzaric: DO NOT crush or chew; CAN be opened and sprinkled on applesauce