Dementia Flashcards
(22 cards)
Alzheimer’s and life expectancy
Reduced life expectancy
Mean survival is 7 years
Death most commonly from BRONCHOPNEUMONIA
Dementia and driving
Assess patient’s ability to drive based on their function
PATIENTS WITH DEMENTIA MUST INFORM THE DVLA
What medication is first line for Alzheimer’s?
Give 3 examples
How do they work?
Acetylcholinesterase inhibitors
Donepezil, rivastigmine, galantamine
Increase cholinergic transmission in the brain
Side effects of Ach inhibitors
Insomnia, GI upset, anorexia
Some cases: increased confusion and agitation
When would you add a second drug for Alzheimers?
What is second line?
If Ach not tolerated or in severe dementia
Memantine (NMDA receptor antagonist)
Side effects of memantine
Diarrhoea, insomnia, dizziness, headache, hallucinations
What are some of the behavioural BPSDs?
wandering restlessness pacing agitation aggression swearing
What are some of the psychological BPSDs?
Anxiety and depression
Insomnia
Delusions
Hallucinations
Possible causes of worsening BPSDs
PINCH ME!
pain, infection, nutrition, constipation, hydration, medication, environment change
How are BPSDs managed?
treat the cause
psycho - aromatherapy, sensory stimulation, environment modification
medication as a LAST RESORT
When is medication indicated for BPSDs?
What is the only licenced medication?
LAST RESORT ONLY!
e.g. agitation/ aggression
Risperidone
What is Lewy body dementia?
Lewy bodies in the brainstem and cortex
Core features of LBD
diagnostic criteria is 2 of these
FLUCTUATIONS in cognitive performance
Features of PARKINSONS
Visual hallucinations
Other associations of LBD (other than the core features)
Sleep disturbance
Depression
Transient loss of consciousness
What is the difference between dementia in PD and LBD
Dementia in PD: PD symptoms for >1 year before cognitive sx
LBD: cognitive symptoms within one year
Why is management of LBD complex?
PD and LBD related to reduced DA
Psychosis = increased DA
BALANCE BETWEEN PD AND PSYCHOTIC SYMPTOMS
Which Ach inhibitor can be used for LBD?
Rivastigmine
What should be avoided in LBD and why?
Antipsychotics
Worsen symptoms of PD
What is fronto-temporal dementia?
How is it diagnosed?
How common is it?
Degeneration of the anterior part of the brain - focal gyral atrophy
MRI for diagnosis!!
AKA Pick’s disease
Rare!
What are the 3 core features of fronto-temporal dementia?
Behavioural changes - change in personality/ diet/ emotional blunting
Progressive non-fluent aphasia - loss of language skills
Semantic dementia - loss of knowledge
What must be avoided in fronto-temporal dementia?
AVOID ACETYLCHOLINESTERASE INHIBITORS!! (can make behavioural abnormalities worse)
What are some rarer causes of dementia?
CJD Huntington's HIV Alcohol and drug abuse Whipple's disease Parkinson's
