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704 Geriatrics > Dementia Agitation > Flashcards

Dementia Agitation Flashcards

1
Q

What are medical causes of agitation in dementia?

A
  • Medication
  • Infection
  • CVA
  • Trauma
  • Pain
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2
Q

What is the future of dementia agitation treatment?

A

Drugs targeting underlying neurobiological mechanisms

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3
Q

What does current treatment for dementia look like?

A

Using currently understood drugs to treat primary psychiatric conditions and symptoms

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4
Q

When do we evaluate for dementia and delirium?

A

Multiple cognitive deficits on cognitive exam after presenting with hallucinations and/or delusions

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5
Q

When do we diagnose mood disorder?

A

Mood symptoms predominate with hallucinations and/or delusions

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6
Q

When do we diagnose schizophrenia?

A

Mood symptoms are minimal with hallucinations and/or delusions. Mood disorder workup is negative.

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7
Q

When do we diagnose delusional disorder?

A

Mood symptoms are minimal and hallucinations are absent. Schizophrenia workup is negative.

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8
Q

T/F: Antipsychotics should be used in patients with dementia-related psychosis

A

FALSE: increased risk of death

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9
Q

T/F: Conventional antipsychotics have a higher risk of death than atypicals in dementia-related psychosis

A

TRUE

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10
Q

Which antipsychotic has the lowest risk of death?

A

Quetiapine (doesn’t mean it’s safe)

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11
Q

What are symptoms of dementia?

A
  • Psychosis (hallucinations/delusions)
  • Depressive symptoms
  • Apathy
  • Manic-like behaviors
  • Agitation or aggression
  • “Sundowning”
  • Insomnia
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12
Q

What is non-pharm for dementia?

A
  • Family and caregivers
  • Structuring physical and psychosocial environment
  • Supervision
  • Scheduled toileting
  • Little help as possible with ADLs
  • Role-modeling
  • Avoid debating, be calm
  • Caregiver support groups
  • Music during meals or bathing
  • Walking or light exercise
  • Simulate family presence (video/audio)
  • Pet therapy
  • Speak at comprehension level
  • Bright light, “white” noise
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13
Q

Where can Alzheimer’s patient caregivers go to get help?

A

Alzheimer’s Association

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14
Q

Schizophrenia is generally diagnosed (younger/older)

A

Younger

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15
Q

How should distress in Parkinson’s be treated?

A
  • Quetiapine or olanzapine
  • Pimavanserin (Nuplazid)
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16
Q

How should we treat Lewy Body Dementia hallucinations?

A

Quetiapine

AVOID 1ST GENS!!!

17
Q

What does Lewy Body Dementia look like?

A

Alzheimer’s with Parkinsonism

18
Q

What is first-line treatment for depressive symptoms in AD?

A

SSRIs (not paroxetine)

19
Q

What antidepressant can help with appetite and insomnia?

A

Mirtazapine (low dose)

20
Q

What antidepressant can help with sedation?

A

Trazodone

21
Q

How can we treat apathy in AD?

A

Methylphenidate, dextroamphetamine, modafinil

22
Q

What can we use to treat manic symptoms in dementia?

A
  • Valproic acid**
  • Lithium
  • Lamotrigine
  • Carbamazepine
23
Q

What is agitation?

A

Uneasiness or inner tension without excessive motor activity

24
Q

What is aggression?

A

A behavioral expression of severe agitation with potential to cause harm to self or others

25
Q

How should we first treat agitation or aggression?

A
  • Avoid triggers if intermittent
  • Exclude discomfort
  • Behavior modification using positive reinforcement
26
Q

What should you avoid doing in agitation/aggression?

A

Physical restraining

27
Q

What first-line pharmacological options do we have for agitation?

A
  • Aripiprazole, olanzapine, quetiapine, risperidone (psychosis)
  • SSRI like citalopram (depression)
  • Buspirone, trazodone (anxiety)
28
Q

What second-line pharmacological options do we have for agitation?

A
  • Carbamazepine
  • Valproic acid*
  • Olanzapine
29
Q

What are options for sexual aggression?

A
  • 2nd gen antipsychotic, divalproex

If no response, try conjugated equine estrogens or medroxyprogesterone

30
Q

What are acute treatment options for sundowning?

A

Night-lights, check-ins

Trazodone, haloperidol, fluphenazine, 2nd gen antipsychotics

31
Q

What are additional options for sundowning that are only for long-term?

A

Melatonin
acute treatment options

32
Q

T/F: Quetiapine can be used for insomnia

A

FALSE: only if sundowning or hallucinations present

33
Q

How do we treat insomnia?

A
  • Avoid triggers (caffeine, fluid intake, light, activity)
  • Trazodone
  • Melatonin
  • BZDs (short-term only)
  • Mirtazapine
34
Q

When can we use brexpiprazole?

A

Agitation in dementia due to Alzheimer’s

BBW for death in dementia-related psychosis

704 Geriatrics (8 decks)

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