Chapter 4 - Dementia Flashcards Preview

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Flashcards in Chapter 4 - Dementia Deck (47)
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1

What is dementia?

A progressive clinical syndrome characterised by a range of cognitive and behavioural changes

2

What are the main types of dementia?

Alzheimer’s Disease
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia

3

What is early onset dementia?

Dementia that occurs before 65 years

4

What usually causes vascular dementia?

Cardiovascular disease, which causes a reduced blood supply to the brain

5

What condition is Dementia with Lewy Bodies often associated with?

Parkinson’s Disease

6

How is dementia usually diagnosed?

Based on symptoms and a clinical assessment tool

7

What are the symptoms of dementia?

Cognitive symptoms
Memory problems
Disorientation
Difficulty carrying out daily tasks

Behavioural problems
Aggression
Agitation
Depression/anxiety
Sleep disorders
Psychosis

8

Which dementia has a stepwise pattern with regards to the severity of symptoms?

Vascular dementia

9

What additional symptoms may be seen with Dementia with Lewy Bodies that aren’t seen in other types of dementia?

Parkinsonian motor features
E.g. Bradycardia, shuffling gait, rigidity

10

What medications can cause cognitive decline?

Anticholinergics e.g. TCAs
Anticonvulsants e.g. phenytoin, phenobarbital
Antipsychotics e.g. haloperidol
Analgesics e.g. NSAIDs, opioids
Benzodiazepines
Corticosteroids

11

What is an example of an assessment tool for dementia?

MMSE

12

What are the 5 principles of the mental capacity act 2005

Assume capacity
Maximise decision making capacity
Freedom to make seemingly unwise decisions
Best interests of the patient
Least invasive option

13

What is a power of lasting attorney?

A document where a person can nominate someone else to make certain decisions on their behalf when they are unable to do so themselves

14

What is advanced decision making?

Allows for people who understand the implications of their decisions to state their treatment wishes in advance

15

Where should treatments for the cognitive symptoms of dementia be initiated?

When can they be issued in primary care?

Secondary care by a specialist

They can then be continued in primary care under a shared care agreement

16

What is anticholinergic burden and what are the effects of this?

The cumulative effect of taking one or more medications with a high anticholinergic activity

Effects include increased risk of falls, delerium, cognitive decline and possibly dementia

17

What are some examples of drugs that significantly increase the anticholinergic burden?

Amitriptyline
Antihistamines e.g. chlorphenamine
Antipsychotics e.g. olanzapine, quetiapine
Urinary antispasmodics e.g. solifenacin, tolteridone, oxybutynin
Hyoscine

18

What drugs are used for the cognitive symptoms associated with dementia, and for which type of dementia are they licensed in?

Donepezil
Rivastigmine
Galantamine
Memantine

Licensed in Alzheimer’s, but also used in some other types of dementia, e.g. dementia with Lewy Bodies

19

What are some side effects associated with donepezil, rivastigmine, galantamine and memantine?

Nausea, dizziness, headache, muscle stiffness, tremor, bradycardia, hypotension (may increase the risk of falls)

20

What is the relationship between acetylcholine and dementia?

Ach is the chemical transmitter for the brain cells that run the memory system

In dementia, the production of Ach in the neurones is reduced

21

What drugs are used in mild Alzheimer’s Disease?

AchE Inhibitors

22

What drugs are used in moderate Alzheimer’s Disease?

First line - AchE Inhibitors

If these are not effective, add on memantine

If these are contraindicated use memantine alone

23

What drugs are used in severe Alzheimer’s Disease?

First line - memantine

24

What can happen if you discontinue AchE Inhibitors?

Worsening cognitive function

25

What drugs are used in dementia with Lewy bodies?

First line - donepezil, rivastigmine

If these aren’t tolerated:
Mild to moderate disease - galantamine
Severe disease - memantine

26

When should AchE Inhibitors be given in vascular dementia?

Only if there is coexisting Alzheimer’s, Parkinson’s of dementia with Lewy bodies

27

What drugs are usually used in vascular dementia?

Aspirin or clopidogrel

28

Do we use AchE inhibitors or memantine in frontotemporal dementia?

No

29

When should antipsychotics be used in dementia?

If the patient is at risk at harming themselves or others, or if they are distressed, agitated, experiencing delusions or hallucinations

30

What is the MRHA warning associated with the use of antipsychotics in dementia?

Increases risk of stroke and small increased risk of death