Dementia
- Created by: Melissaloughlin
- Created on: 13-05-23 13:46
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- Dementia
- Types
- Alzheimer's (MOST COMMON)
- Progresses steadily over time
- Amyloid plaques - clumps of beta-amyloid
- Neurofibrillary tangles - bundles of filaments within neurons (tau protein)
- Accumulation of these lead to reduction of information transmission - lead to brain cell death
- Amyloid plaques - clumps of beta-amyloid
- Accumulation of these lead to reduction of information transmission - lead to brain cell death
- Can affect all areas of the brain
- Memory loss is common
- Dementia with lewy bodies
- Rapidly progresses
- Lewy body proteins (alpha-synuclein) deposited in brain
- Also present in Parkinson's disease
- Parkinson's-like symptoms
- Sleep disorders and cognitive fluctuations are common
- Vascular dementia
- (due to cerebro-vascular disease)
- Risk factors: Smoking, hypertension, diabetes, obesity,
- Commonly due to multiple small cerebro-vascular infarcts
- Increased risk after a stroke
- Progresses in a stepwise fashion
- Stable
- Acute Decline
- Stable again
- Acute Decline
- Stable
- Mood disorders are common
- Mixed dementia
- Can be a mix of 2 or 3 different types of dementia
- Fronto-temporal dementia
- Alzheimer's (MOST COMMON)
- Range of cognitive and behavioural symptoms
- Memory loss
- Problems with reasoning and communi-cation
- Change in personality
- Reduced ability to carry out daily activities
- Progressive & irreversible disease
- Aims of treatment
- Promote independence
- Maintain function
- Manage symptoms
- Maintain function
- Promote independence
- Treatment
- Non-drug treatment
- All pt. with mild-mod dementia
- Offered group cognitive stimulation programme
- Group reminiscence therapy
- Cognitive rehabilitation/OT
- All pt. with mild-mod dementia
- Drug treatment
- Mild-Moderate Alzheimers
- 1st line: Acetylcholine-esterase Inhibitors
- Donepezil
- 5mg up to 10mg at bedtime
- Neuroleptic Malignant Syndrome (NMS)
- Rivastigmine
- 1.5mg BD up to 6mg BD
- Comes in a patch
- Apply to clean, dry, non-hairy/irritated skin on back, upper arm or chest
- initially: 4.6mg/24hr maintenance: 9.5mg/24hr max: 13.3mg/24hr
- Risk of fatal overdose with errors
- GI side effects - discontinue patch
- Galantamine
- 8mg up to 16-24mg
- Skin rash - discontinue
- Increases conc. of Ach at sites of neuro-transmission
- Anti-muscarinics can antagonise these effects
- Donepezil
- Alternative or additive therapy: NMDA Receptor Antagonists
- Memantine
- Not recommend in fronto-temporal dementia or cognitive impairment caused by MS
- 5mg up to 20mg daily
- Renal dose reduction
- Blocks effects of elevated glutamate - which can cause neuronal dysfunction
- Memantine
- 1st line: Acetylcholine-esterase Inhibitors
- Severe Alzheimers
- Memantine
- Not recommend in fronto-temporal dementia or cognitive impairment caused by MS
- 5mg up to 20mg daily
- Renal dose reduction
- Memantine
- Anti-psychotics
- severe agitation or distress
- Licensed: Haloperidol & Risperidone
- Mild-Moderate Alzheimers
- Non-drug treatment
- Diagnosis - MMSE scoring system
- Must inform DVLA of diagnosis
- Types
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