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Therapeutics > Dementia > Flashcards

Dementia Flashcards

1
Q

What is cognitive impairment?

A

An abnormal change in how a person thinks, emotionally responds, or behaves; may involve changes in one or more cognitive domains.

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2
Q

What are the most common causes of cognitive impairment in seniors?

A

Dementia, delirium and depression.

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3
Q

What are non-modifiable risk factors for dementia?

A

Age (>60), genetics.

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4
Q

What are modifiable risk factors for dementia?

A

Vascular conditions: high cholesterol, diabetes, HTN, stroke, head trauma
Lifestyle behaviours: smoking, high fats diet, excess alcohol intake, lower education

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5
Q

What is the pathophysiology of dementia?

A

Neurofibrillary tangles (intracellular bundles of abnormal tau protein), and neuritic plaques (extracellular protein deposits of beta-amyloid protein)

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6
Q

What are the main categories of symptoms of dementia?

A

Cognitive (memory loss), functional (inability to care for oneself), and behavioural (depression, psychosis, agitation, aggression)

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7
Q

How is dementia diagnosed?

A

Patient history (risk factors, family history), family interview, physical exam (signs of stroke?), brief cognitive tests (MMSE, clock drawing test, MoCA, FAST, ADAS-Cog), lab investigations, neuroimaging.

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8
Q

What’s the best cognitive test is most sensitive for mild dementia?

A

Montreal Cognitive Assessment (MoCA)

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9
Q

What lab investigations are done in diagnosing dementia?

A

CBC, TSH, calcium, electrolytes, vitamin B12, BG

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10
Q

What are the goals of therapy for dementia? (5)

A
  1. Stabilize and slow further cognitive decline
  2. Maintain functioning socialization
  3. Treat behavioural and psychological symptoms
  4. Minimize medication side effects
  5. Alleviate caregiver burden
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11
Q

What are non-pharm Txs for dementia?

A

Educate patient and family, exercise, avoid meds that are worsening the condition (sedatives, anticholinergics), simple and structured life, pet therapy, behavioural therapy.
Refer to Alzheimer Society.

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12
Q

Can Vitamin E be used to treat dementia?

A

No. High doses may cause more harm than benefit b/c of side effects.

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13
Q

Can Gingko Biloba be used to treat dementia?

A

Insufficient evident for or against use.

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14
Q

Can NSAIDs be used to treat dementia?

A

No evidence.

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15
Q

Can Estrogen be used to treat dementia?

A

No evidence.

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16
Q

Can Statins be used to treat dementia?

A

No evidence.

17
Q

What drugs are the main choice for Tx of dementia?

A

Cholinesterase Inhibitors (Donepezil, Galantamine, Rivastigmine)

18
Q

When do you see an effect with cholinesterase inhibitors?

A

Adequate trial is 3-6 months.

19
Q

How do you monitor for efficacy of Txs?

A

Monitor cognition, behaviour and function every 3-6 months. And have defined target symptoms to scale.

20
Q

What are the side effects of CEIs?

A

GI (dyspepsia, N/V, diarrhea, abdominal pain)
Cardiac (dizziness, orthostatic hypotension, bradycardia)
Muscle cramps
Insomnia
Headaches

21
Q

What are the side effects of memantine?

A

Dizziness, headache, constipation.

22
Q

What drug interactions should you keep in mind when treating dementia?

A

CYP450 interactions (esp. w/ CEIs) and interactions w/ anticholinergic meds (prob want to avoid these.

23
Q

Describe the early course of AD.

A

Memory loss, difficulty with word finding, difficulties w/ instrumental ADLs, irritable, depressed, refuse assessment for cognitive decline.

24
Q

Describe the intermediate/moderate course of AD.

A

Cognition declines, patients lose insight, behavioural disturbances emerge, basic ADLs become impaired (DEATH)

25
Q

Describe the late course of AD.

A

Loss of language, profound loss of functioning, patients require around the clock care and assistance with all ADLs

26
Q

What CEIs are indicated for treatment of mild-moderate AD?

A

Galantamine and Rivastigmine

27
Q

What CEI is indicated for treatment of severe AD?

A

Donepezil

28
Q

Patients with what pre-existing conditions indicate a cautious initiation of CEIs?

A

Seizure disorders, asthma, arrhythmias, urinary retention, active GI ulcers. (conditions that may be exacerbated by cholinergic stimulation)

29
Q

When do you use memantine for Tx of AD?

A

For moderate to severe disease.

30
Q

What CEI has the worst GI side effects?

A

Rivastigmine.

31
Q

What side effects are common with Donepezil?

A

Headache, N/V, insomnia, pain

32
Q

What side effects are common with Rivastigmine?

A

Headache, N/V, dizziness, diarrhea (patch has less N/V)

33
Q

What side effects are common with Galantamine?

A

Headache, N/V, dizziness, injury.

Therapeutics (9 decks)

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