Dementia - general info Flashcards
(17 cards)
Dementia
A group of symptoms that affects memory, thinking and interferes with daily life.
Caused by damage to the brain - can occur due to diseases such as AD, stroke or PD
Cognitive symptoms
Memory loss
Difficulty thinking e.g. concentration or problem solving
Language e.g. can’t find the right word.
Orientation e.g. losing track of date/time
Non-cognitive symptoms
Psychiatric and behavioural problems e.g. delusions or aggression
Difficulties with daily activities
Mild-moderate AD
Acetylcholinesterase inhibitors (anticholinesterase)
* Donepezil
* Galantamine
* Rivastigmine
CONTRAINDICATED IN MODERATE/SEVERE AD
Donepezil
Neuroleptic malignant syndrome.
Risk increased with concomitant antipsychotics
Galantamine
Serious skin reactions can occur.
Stop at first appearance of skin rash
Rivastigmine
Used in PD
GI disturbances - withhold until resolved
Transdermal patches = less GI side effects
Acetylcholine
Neurotransmitter crucial for memory and learning.
Acetylcholinesterase
Enzyme that breaks down acetylcholine.
Acetylcholinesterase inhibitors - MoA
In AD, cholinergic neurons that produce acetylcholine are lost.
Acetylcholinesterase inhibitors (donepezil, rivastigmine + galantamine) inhibit acetylcholinesterase, which leads to high acetylcholine levels.
Acetylcholine stays active in the brain for a longer time.
Improves cognitive function and slow down memory loss/decline.
Cholinergic side effects
Acetylcholinesterase inhibitors have cholinergic side effects.
Symptoms and physiological responses that occur due to increase activity of acetylcholine.
DUMB BELS
DUMB BELS
Diarrhoea
Urination
Muscle weakness, muscle cramps, miosis
Bronchospasm
Bradycardia
Emesis (vomiting)
Lacrimation (teary eyes)
Salivation/ sweating
Moderate-severe AD
NMDA glutamate receptor antagonist
* Memantine
AD + NMDA activity
AD = excessive activation of NMDA receptors = excitotoxicity (high levels of intracellular calcium which contributes to neuronal damage).
NMDA glutamate receptor antagonist
Memantine modulates NMDA receptor activity by blocking excess calcium influx.
Helps regulate excitotoxicity.
Management of non-cognitive symptoms
Anti-psychotic rugs for severe non-cognitive symptoms causing significant distress or immediate risk of harm to self or others.
- Oral benzodiazepines or antipsychotic.
- IM needed = haloperidol, olanzapine, lorazepam
Anti-psychotic drugs - MHRA advice
MHRA advice (2009): CLEAR increased risk of stroke and death when antipsychotics are used in elderly patients with dementia.
Carefully assess benefit vs. risk, looking at:
- Stroke/transient ischaemic attack
- Cerebrovascular disease risk factors (HF, diabetes, AF, smoking)
