Flashcards in Dementia and alzheimer's Deck (27)
What is the best-known cause of dementia?
What are some of the symptoms of AD?
What are the two abnormal proteins that build in the brain in AD?
What is the amyloid cascade hypothesis?
APP is found in the membrane of neurones. When it gets cut up by alpha-secretase and gamma-secretase it is fine - soluble peptide.
When APP gets broken up by B-secretase and gamma-secretase, the peptide formed is insoluble and creates a monomer called amyloid-B which is sticky and clumps together to form oligomers -> plaques
What are the three main types of dementia?
Dementia with lewy bodies
What are the three stages of dementia severity?
Mild - prominent memory loss. Core activities of daily function are maintained but higher level functions impaired
Moderate - worsening cognition. Core activities of daily function now affected, Challenging behaviour may become more prominent
Severe - apathy and dependency prominent. Many patients receiving 24hr care
How is dementia diagnosed according to ICD-10?
Memory loss must be present plus decline in one other domain of cognition e.g. judging, reasoning, planning such that it interferes with activities of daily life
Some change in social behaviour
Decline lasting at least 6 months
Drug treatments are only licensed for which type of dementia?
What is the main drug treatment for AD?
Name a acetylcholinesterase inhibitor used in the treatment of AD
Name the NMDA antagonist that is licensed for use in AD
What are some of the non-pharmacological treatment options for dementia?
Lifestyle factor modification e.g. stopping smoking, exercise, 5-a day
Routine and familiarity are important for maintaining independence so keep diary etc.
Use of colour and increasing size helps to enhance visibility
Cognitive stimulation therapy - promotes calmness and engagement with others
Treat co-morbid depression/sleep disorders
When is memantine used in the treatment of AD?
Moderate AD in patients who cannot take AChE inhibitors or in severe AD
When should combination therapy with AChE inhibitor and memantine be considered?
Consider in moderate disease
Should be offered in severe disease
Which is the lowest cost AChE inhibitor that is usually used in AD?
Which drugs should not be used in the treatment of vascular dementia?
AChE inhibitors or memantine.
Unless used to treat co-morbid AD
What are the treatment options for dementia with lewy bodies?
Donepezil or rivastigmine in mild-moderate
Galantamine in severe
Offer memantine if AChE inhibitors C/I
If patient has poor tolerability to one AChE inhibitor does that meant they will have poor tolerability to others?
When starting treatment with galantamine, when can the dose be increased?
Start low and increase dose after 1 month
When starting treatment with memantine, when can dose be increased?
Start low and increase after 1 week
When starting treatment with rivastigmine, when can dose be increased?
Start low and increase after 2 weeks
Which drug is available in a patch formulation?
Rivastigmine - site of patch should be changed daily and previous sites should be avoided for 14 days.
Other than cognitive symptoms, what symptoms may dementia patients experience?
Behavioural and psychological symptoms
List some behavioural and psychological symptoms of dementia
How can BPSD be managed?
Try to rule out other causes of BPSD using PAIN acronym:
Physical problems - infection, pain, constipation?
Activity related - washing, dressing?
Iatrogenic - side effects of meds?
Noise and other environmental factors such as lighting
When are meds used in BPSD?
Only in severe distress or immediate risk of harm to others or person with dementia