Dementia

Question 1

Mild to moderate Alzheimers first line

Answer 1

Mono therapy with donepezil, galantamine or rivastigimine (acetylcholinesterase inhbitors)
If CI= Memantine

Question 2

Moderate to severe alzheimer treatment

Answer 2

Acetylcholinesterase inhibitor + memantine

Question 3

Severe alzheimer disease treatment

Answer 3

Memantine

Question 4

management of cognitive symptoms

Answer 4

The use of drugs that contribute to anticholinergic/antimuscaranic burden should be minimised e.g. olazapine, quetiapine, amitriptyline, paroxetine, solifenacin

Question 5

Discontinuation of acetylcholinesterase inhibitors in moderate Alzheimers

Answer 5

Can cause significant worsening in cognitive function; treatment discontinuation should not be based on disease severity alone

Question 6

mild-moderate dementia with Lewy bodies treatment

Answer 6

Doneprizil or rivastigimine
Only consider galantamine if both not tolerated

Question 7

Severe dementia with lewy bodies treatment

Answer 7

Doneprizil or rivastigimine
Memantine if CI or not tolerated

Question 8

FTD treatment

Answer 8

Both acetylcholinesterase inhibitors and memantine not recommended

Question 9

Vascular dementia treatment

Answer 9

Acetylcholinesterase inhibitors [unlicensed indication] or memantine hydrochloride [unlicensed indication] should only be considered in patients with vascular dementia if they have suspected co-morbid Alzheimer’s disease, Parkinson’s disease dementia, or dementia with Lewy bodies.

Question 10

When should antipsychotics be used in dementia

Answer 10

Only when they are at risk of harming themselves/others or are experiencing agitation/hallucinations or delusions that are causing them severe distress

MHRA: INCREASE RISK OF STROKE/DEATH when antipsychotics are used in elderly patients with dementia

Question 11

Galantamine side effects

Answer 11

Serious skin reactions
Chest pain
Dizziness/fainting
SOB
Shakiness of limbs
Irregular/slow Heart Beat

Question 12

Management of depression and anxiety in dementia

Answer 12

If mild dementia and mild depression/anxiety -> offer CBT, Multisensory stimulation relaxation or animal assisted therapies

Antidepressants should be reserved for pre-existing mental health issues

Question 13

Management of sleep disturbances in dementia

Answer 13

Non drug approaches to manage including sleep hygiene, exposure to daylight and increasing exercise and activity