Dementia Flashcards
What is dementia
Dementia is a progressive and irreversible syndrome characterised by impaired mental function. Alzheimer’s disease is the most common cause of dementia and symptoms include problems with memory, concentration and problem solving
Non-cognitive symptoms include
behavioural problems and difficulties with activities of daily living.
Drug therapy for Alzheimer’s
should be initiated by a specialist and assessment of their effectiveness should be carried out after around 3 months… this can be difficult since the disease may have deteriorated in this time.
- If there is no apparent benefit but disease worsens significantly upon stopping then consider restarting
- Donepezil, Galantamine + Rivastigmine are Acetylcholinesterase Inhibitors (AChEI) used to treat symptoms of mild-moderate dementia due to Alzheimer’s
suitable alternative for patients with moderate Alzheimer’s when AChEI are contraindicated or not tolerated
Memantine is a suitable alternative for patients with moderate Alzheimer’s when AChEI are contraindicated or not tolerated. It can also be used treat severe symptoms
When are Acetylcholinesterase Inhibitors and memantine not recommended
Acetylcholinesterase Inhibitors and memantine are not recommended in patients with frontotemporal dementia or cognitive impairment caused by multiple sclerosis
Management of violence, aggression and extreme agitation (non-cognitive symptoms)
In cases of dementia associated with severe behavioural disturbance (if violence, aggression or agitation threatens safety of patient/others), give an antipsychotic drug or benzodiazepine. The Lowest effective dose should be used for the shortest time possible, with regular reviews at least every 6 weeks.
MHRA reported (2009)
an increased risk of stroke and a small increased risk of death when antipsychotic drugs are used in elderly patients with dementia
