Dementia Flashcards
what is dementia?
- Dementia is a clinical syndrome that includes difficulties in memory, language, and behaviour which lead to a deterioration in the ability to perform activities of daily living
- Whilst cognition may decline gradually as someone ages, dementia may be suspected when the speed and/or nature of this decline is distinct from the natural ageing process
what is cognition?
- Memory
- Language
- Awareness and orientation
- Learning and understanding
- Attention/concentration
- Reasoning
- Decision making/Problem solving
what are the symptoms of vascular dementia?
- decline can be gradual
- memory may be preserved
- phsyical symptoms include slurred speech, dizziness, motor task issues
what are the symptoms of AD?
memory impairment
difficulty finding words
problems performing ADL
wwhat are the symptoms are lewy bodies dementia?
cognitive slowing important feature
reduce motor function
what are the 3 stages of dementia severity?
o Mild: short term memory loss. Core activities of daily living (ADL) maintained but higher level functions impaired
o Moderate: worsening cognition. Core ADL now affected. Challenging behaviours may become more prominent
o Severe: apathy and dependency prominent. Long term memory loss. Many patients receiving 24 hour care
what are the types of dementia?
o Alzheimer’s Disease (AD)
o Vascular Dementia (VD)
o Dementia with Lewy Bodies (DLB)
o Fronto-temporal Dementia (FTD) [not examinable]
o Parkinson’s Dementia (PD) [not examinable]
o Alcohol related [not examinable]
how is dementia diagnosed?
- Diagnosing dementia is not straightforward
- An accurate and comprehensive history is vital, including physical and mental state exam
- Check routine haematology, biochemistry, thyroid, vitamin B12 and folate
- Check mid-stream urine, X-Ray/ECG if required
- Opportunistic screening – e.g. hospital admission, NHS Health Checks
- CT and MRI scans can be used to exclude space occupying lesions such as tumours
- According to ICD-10
- Memory loss must be present
- Plus decline in one other domain of cognition (e.g. judging, reasoning, planning) such as that it interferes with activities of daily living (ADLs)
- Some change in social behaviour (e.g. irritable, apathy, lability)
- Decline lasting at least 6 months
how do you treat dementia?
- Treatment is not curative
- Multiple drug and non-drug treatments may be needed to control the illness
- Treatment should be guided by a holistic view of the patient and their carer(s)
what are the drug treatment options for dementia?
- Acetlycholinesterase inhibitors (AChE-I) are the main drug treatment
- Rivastigmine (also targets ButE), donepezil, galantamine
- Drugs can prolong current level of functioning or improve symptoms
• Memantine is a NMDA antagonist and is the only other drug licensed
what are the cautions when using AChE-I?
- Sick sinus syndrome or cardiac conduction conditions (e.g. sinoatrial block)
- Those at risk of ulcers
- History of asthma/COPD
- Renal/hepatic impairment, more specific advice for memantine
- Adverse drug reactions (ADRs) of AChE inhibitors are often self limiting and include:
- GI: N&V, anorexia, ulceration, upset
- CNS: Alertness and agitation, hallucinations, dizziness, insomnia, seizures
- GUS: Urinary incontinence
- Cardiac: Bradycardia, sinoatrial/atrioventricular block
what are the non-pharmcological treatment options?
- Lifestyle factor modification is a significant part of dementia prevention/amelioration
- Stop smoking, tackle obesity, reduce alcohol, 5-a-day, proper exercise, sugar/salt/fat management
- Familiarity and routine are important for maintaining independence and function
- Keep a diary or use reminder charts
- Remember rooms are designed to look like by-gone era’s
- Enhancing visibility another avenue
- Use colour and size to make things stand out, e.g. telephones, toilets and doorways
- Orientation boards containing date, weather symbols and time
- Consider holistic needs
- Cultural, religious, falls risk, SALT, dementia patients cannot change
- Treat co-morbid depression/anxiety and sleep disorders
- Cognitive stimulation therapy (CST)
- Challenging behaviours
what are the NICE guidelines for AD?
AChE inhibitors rivastigmine, galantamine and donepezil recommended for mild-moderate AD
• Use drug with lowest acquisition cost, but can also consider ADR profile, adherence, interactions and co-morbidities
NMDA antagonist memantine recommended as monotherapy for:
- Moderate AD, in those who cannot take a AChE (intolerance or contraindication)
- Severe AD
Combination therapy with memantine should be:
- Considered if moderate disease
- Offered if severe disease
what are the treatments for VD and DLB?
DO NOT use AChE inhibitors or memantine for treatment of VD, except if co-morbid AD
• Risk factor control continues to be central to VD treatment
• Treating hypertension effective
- Offer donepezil or rivastigmine to those with mild-moderate DLB, galantamine in reserve. Consider these in severe DLB. Offer memantine if AChE not tolerated/contraindicatred
what drugs need to be avoided in dementia?
o Anticholinergic (antimuscarinics) o Hyoscine hydrobromide (NOT butylbromide) o Procyclidine o Oxybutynin o Promethazine o Orphenadrine • Antidepressants • Antipsychotics • Alpha blockers o Prazosin o Tamsulosin • Opiates • Benzodiazepines • Sedating antihistamines
