Dementia Flashcards
(21 cards)
What is dementia?
- causes
- types
- symptoms
- risk factors
progressive clinical syndrome
- low acetylcholine
- lewy body formation
alzheimer’s, vascular, Lewy bodies, mixed
cognitive dysfunction, behavioural symptoms, difficulty with activities of daily living
HTN, smoking, obesity, > alcohol consumption
age, learning disability, CVD, Parkinson’s disease, vitamin deficiencies, autoimmune disorders
What is the treatment for Alzheimer’s dementia?
- mild to moderate
- moderate to severe
mild to moderate: acetylcholinesterase inhibitors
- donepezil, galantamine, rivastigmine
moderate to severe: NMDA/ glutamate receptor antagonist
- memantine (instead or add on)
discontinuation can worsen congnitive function
What are drugs that increase cholinergic burden?
- worsen cognitive function
antidepressants: amitriptyline hydrochloride, paroxetine
antihistamines: chlorphenamine maleate, promethazine hydrochloride
antipsychotics: olanzapine, quetiapine
urinary antispasmodics: solifenacin succinate, tolterodine tartrate
What is the treatment for Non-Alzheimer’s disease?
- dementia with lewy bodies
- vascular dementia
- frontotemporal dementia, cognitive impairment caused by MS
- Parkinson’s disease dementia
dementia with lewy bodies: UNLICENSED
- donepezil or rivastigmine then galantamine
- memantine (last line)
vascular dementia: UNLICENSED
- AchE inhibitors or memantine
frontotemporal dementia, cognitive impairment caused by MS
- AVOID AchE inhibitors and memantine
Parkinson’s disease dementia
- rivastigmine: LICENSED
- AchE inhibitors: UNLICENSED
- memantine: UNLICENSED
What is a caution for donepezil and galantamine?
concomitant antipsychotic use
- increased risk of neuroleptic malignant syndrome
- discontinue treatment
What are the side effects of donepezil?
urinary incontinence
agitation
aggression
n+v
insomnia
What are side effects of galantamine?
- red flag
dizziness, drowsiness: fall risk
Gi disorder
asthenia
arrhythmias
skin rash: risk of Steven Johnsons syndrome - discontinue
What are the counselling points for galantamine?
skin rash, serious skin condition
- discontinue
What is the MHRA warning for rivastigmine?
differently bioavailability between daily vs weekly transdermal patches
What is counselling point for rivastigimine regarding dose?
if titration/treatment is interrupted for more than 3 days: restart from 4.6 mg/24 hours patch or 1.5 mg twice daily orally
When should treatment be interrupted for rivastigmine?
dehydration from prolonged diarrhoea or vomiting occurs
- dehydration is also a side effect
withhold until resolution
retitrate if necessary
can also be held if GI side effects occur
What monitoring is required for rivastigmine?
body weight
- appetite loss and weight loss is a side effect
How do acetylcholinesterase inhibitors affect driving?
side effects: drowsiness, fatigue, syncope, delirium, syncope
What are the main drug interactions for memantine?
dopaminergic: increases their effects
- rotigotine, levodopa, bromocriptine
amantadine, ketamine: increased risk of CNS toxicity
When should antipsychotics be offered in dementia?
if they are either at risk of harming themselves or others, or experiencing agitation, hallucinations or delusions that are causing them severe distress
What are the non-cognitive symptoms of dementia?
agitation, aggression, distress and psychosis
depression and anxiety
sleep disturbances
Which antipsychotics are licensed for use in dementia?
risperidone
haloperidol
What is the MHRA warning for antipsychotic use in dementia?
increased risk of stroke and a small increased risk of death when antipsychotic drugs are used in elderly patients with dementia.
In which types of dementia are antipsychotics not helpful?
dementia with Lewy bodies or Parkinson’s disease dementia
- antipsychotic drugs can worsen the motor features of the condition
How should antipsychotics be used in dementia?
lowest effective dose
for the shortest time possible
regular review at least every 6 weeks
When should antidepressants be used in dementia?
if there are pre-existing severe mental health problems
