Intervention

Question 1

Pharmacological interventions AD

Answer 1

Recent, promising, drugs – remove beta-amyloid from the brain
 Aducanumab (Aduhelm®)
- not in Europe, now withdrawn

 Lecanemab (Leqembi®)
- for early stage, slows down progression

 Donanemab
- For early stage dementia/MCI

BUT; very expensive

For enhancing cognition (symptoms)
◼ Acetylcholinesterase inhibitors – to increase ACh levels (mild/moderate stage, does have side-effects)
- Donepezil, rivastigmine, galantamine

◼ Glutamate antagonist (N-Methyl-D-Aspartate - NMDA) – to reduce activity glutamate neurotransmitter (severe stage)
- Memantine

Question 2

Pharmacological interventions MCI

Answer 2

Acetylcholinesterase inhibitors
- Little effect on cognition (ADAS-Cog, MMSE)
- Little evidence intervention reduced progression to dementia

Problem is heterogeneity of causes MCI

For VCI:
- No established intervention, inhibitors and NMDA used but effect mixed and side effects frequent
- Interventions mostly aimed to reduce modifiable risk factors

Question 3

Pharmacological interventions DLB and PDD

Answer 3

Acetylcholinesterase inhibitors
- Some evidence positive effect cognition in PDD
- Little evidence effect in DLB

Levadopa/L-dopa for motor symptoms

Question 4

Pharmacological interventions for symptoms

Answer 4

In FTD; only symptomatic treatment for cognition/behaviour
- Cholinesterase inhibitors (like donepezil) and memantine are not effective for FTD and may worsen behavioral symptoms, unlike in Alzheimer’s disease.

Cognition
- Anti-depressants (eg SSRIs)
- Anti-anxiety (eg Pams or Trazodone)
- Antipsychotics (w caution, can have neg effects)

Question 5

Non-pharma interventions

Answer 5

• Effects cognition or behaviour usually small
• Most effective in earlier stages dementia
• Multi-component intervention more effective
• Often only available intervention option

Less expensive to develop and to implement

easier to tailor to individual

Less likely to produce side effects

Question 6

Cognitive training

Answer 6

Guided practice on set of tasks with goal to improve cognitive function
- Used in healthy elderly and dementia
- Eg sudokus, brain training.

Doesn’t generalize, little benefit (some for MCI)

Used for normal ageing, SCD, MCI

Question 7

Cognitive rehabilitation

Answer 7

Emphasis on improving everyday functioning rather than performance on cognitive tasks
- using compensating strategies instead of restitution of function

Positive effect on memory, sense of competence and quality of life

Used for normal ageing, SCD, MCI, dementia

Question 8

Cognitive stimulation

Answer 8

Engage in pleasurable activities to stimulate cognitive functioning with aim to improve cognitive functions, e.g. memory, attention

Positive effect on QoL, but no effect on daily functioning

Used for normal ageing, SCD, MCI, dementia

Question 9

Interventions for caregivers

Answer 9

Most are aimed here; educating in
- improve caregivers’ knowledge of dementia
- identify, modify factors cause/exacerbate behavioural symptoms

Educate family to cope with behaviour
- e.g. “go along”, give reassurance, instead trying to reason with the patient

Improve CG wellbeing and sense of competence, reduced CG burden
- PWD can live at home longer
- Train CG to present intervention; Cost-effectiveness