Dementia

Question 1

What is dementia? What are the symptoms?

Answer 1

A progressive, irreversible clinical syndrome with a range of cognitive and behavioural symptoms including
- memory loss
- problems with reasoning and communication
- change in personality
- reduction in the person’s ability to carry out daily activities.

Question 2

What is the main cause of Alzheimer’s dementia?

Answer 2

Abnormal build-up of amyloid and tau proteins

Question 3

Which neurotransmitter is lower in those with Alzheimer’s dementia?

Answer 3

Acetylcholine

Question 4

Which drugs are used first line in the management of cognitive symptoms Alzheimer’s disease?

Answer 4

Acetylcholinesterase inhibitors

Question 5

Examples of Acetylcholinesterase inhibitors

Answer 5

• donepezil
• galantamine
• rivastigmine

Question 6

What drug can be added to acetylcholinesterase inhibitors, or used as monotherpay, in the management of cognitive symptoms Alzheimer’s disease?

Answer 6

Glutamate receptor antagonist (Mematine)

Question 7

Example of Glutamate receptor antagonist

Answer 7

Mematine

Question 8

Which drugs are used first line in the management of cognitive symptoms in dementia with Lewy bodies?

Answer 8

Donepezil or rivastigmine
- memantine can be considered as an alternative if acetylcholinesterase inhibitors are contra-indicated/ not tolerated

Question 9

How do acetylcholinesterase inhibitors work?

Answer 9

They inhibit the cholinesterase enzyme that break down acetylcholine in the CNS
- this increases the availability of acetylcholine for neurotransmission to improve cognitive functioning
- decrease disease progression

Question 10

acetylcholinesterase inhibitors adverse effects?

Answer 10

GI upset- diarrhoea
Extrapyramidal side effects
Lacrimation (tears) and salivation
Bradycardia

Question 11

What is a rare but serious side effect of donezepil?

Answer 11

Neuroleptic malignant syndrome, a potentially life-threatening condition characterized by
- hyperthermia
- muscle rigidity
- autonomic instability
-fluctuating consciousness

Question 12

What is an alternative formulation of rivastigmine used for those with swallowing difficulties?

Answer 12

A patch

Question 13

What is used for the management of aggregation, aggression or psychosis associated with dementia?

Answer 13

risperidone, haloperidol or Quetiapine

Question 14

Can antipsychotics be used in elderly patients with dementia? (MHRA warning)

Answer 14

• antipsychotics increase the chances of having a strokes in those with dementia
• they can be used in a risk vs benefit basis (e.g. if the patient is harming themselves or others, or hallucinations are causing them severe stress)