Geriatrics Dementias

  1. what is the MMSE
    screening tool for cognitive impairment; NOT intended to diagnose AD/dementia
  2. MMSE scoring
    • normal 24-30
    • mild 17-23
    • moderate 10-16
    • severe < 10
  3. what is the Blessed Dementia Scale
    clinical rating scale with 22 items that measure changes in performance of every day activities

    based on info from relatives or friends
  4. Evaluation tools of dementia
    • cognition (MMSE, ADAS)
    • depression (depression scale)
    • function (ADLs and IADLs)
    • Others (CIBIC, NPI, SIB)
  5. ADLs
    • activites of daily living which measures self care tasks such as;
    • personal hygiene and grooming
    • dressing and undressing
    • self feeding 
    • functional transfers
    • bowel and bladder management
    • ambulation
  6. IADLs
    • instrumental activities of daily living;
    • housework
    • taking medications as prescribed
    • money mgmt
    • use of technology
    • shopping for groceries
  7. what is dementia
    a syndrome that exhibits impaired short and long term memory as its most prominent feature
  8. four major anatomical changes that causes dementia
    • cortical atrophy
    • degeneration of cholinergic and other neurons
    • neurofibrillary tangles
    • neuritic plaques
  9. clinical presentation of dementia
    • cognitive deficits occurring PROGRESSIVELY
    • -4 to 6 point drop in MMSE over 1 yr
    • symptoms;
    •   cognition (memory loss, apraxia, agnosia
    •   non-cog (depression, psychotic symptoms 
    •   functional behavior (IADLs and ADLs)
  10. medications that cause differential diagnosis
    • anticonvulsants 
    • anticholinergic
    • anxiolytics
  11. donepezil brand name/dosing
    • aricept
    • initial dosing 5-10 (mild to moderate)
    • -adjust q 4-6 wks
    • 10-23mg for severe 
    • -adj q >=3mths
  12. how should donepezil be administered
    HS w or w/out meals
  13. Rivastigmine brand name/dosing
    • exelon
    • PO; initial 1.5 BID adjust every 4wks
    • -max dosing (6mg BID)
    • patch; 4.6mg daily
    •           9.5mg daily (max)
  14. rivastigmine administration
    take with meals; patch-upper or lower back
  15. galantamine brand name/dosing
    • razadyne
    • initial dosing; IR-4mg BID increase q 4wks
    •                     ER-8mg daily increase q 4wks
    • -max dosing 24mg daily
  16. razadyne max dosing for renal or hepatic impairment
  17. investigational agents used for AD
    • estrogen
    • NSAIDS
    • MAOI
    • gingko biloba
    • vitamin E
  18. how to select pharmacotherapy
    • dementia severity
    • history of prior response
    • AE profile
    • Co-morbidities
    • concomitant medications (DDI)
    • ease of adherence (QD vs BID; dose form)
    • Cost
  19. which dementia drug has the least amt of adverse effects
    rivastigmine due to its metabolic pathway
  20. monitoring paramaters
    • behavior
    • mood
    • bowel function
    • cognitive function
    • general function
    • adverse effects
  21. when will small improvements in cognition and function be observable
    at 4-6 wks
  22. when do you switch to another AChEI
    after 12-24 wks if no improvement is seen (no need to try a third agent)
  23. what do you do if AChEI therapy is interrupted for more than a few days
    re-titrate from the starting dose
  24. how can donepezil be administered if pt is having insomnia and vivid dreams/nightmares
    AM dosing
  25. risk factors for VaD
    • advanced age
    • DM
    • small vessel cerebrovascular disease
    • HTN
    • hyperlipidemia
    • cigarette smoke
    • alcohol use
    • males>females
  26. clinical presentation of VaD
    • -decline in cognitive impairment
    • -personality and mood changes
    • -early presence of gait disturbance, unsteadiness, unprovoked falls
    • -urinary frequency, urgency, incontinence
  27. which drug is has shown clinical significance for treating VaD
    aricept and namenda
  28. secondary prevention of VaD
    • bloop pressure (CCB)
    • Cholesterol
    • DM
    • antiplatelet therapy
    • smoking cessation
    • decrease or D/C alcohol use
    • lifestyle modifications
  29. how to treat a pt with excessive worrying, sleep disturbances, rumination
    • anxiety; trazodone, buspirone (if no insomnia)
    •              or short acting BZD, SSRI
  30. how to treat a pt with withdrawal, loss of appetite, irritability, restleness, sleep disturbances
    Depression; trazodone, SSRI
  31. how to treat a pt with repeat questions, wandering, pacing
    often unresponsive to medications; redirect pt activity
  32. how to treat a pt with delusions (often is of theft), hallucinations, misperceptions
    psychotic behaviors; AAP (if w/ paranoid features), SSRI
  33. how to treat a pt with physical or verbal aggressivenes toward others, exvessive yelling and screaming
    aggresive behaviors; anticonvulsant, such as divalproex or carbamazepine with AAP
  34. what is the CATIE-AD trial
    pts w/ dementia and psychosis or agitated behavior should be treated with AAP
  35. what must you treat in pts with lewy body dementia
    • cognition/memory: AChEI
    • Parkinsonism: Levodopa/Carbidopa
  36. medications that cause pseudodementia
    • psychotropics
    • analgesics
    • anti-hypertensives
    • corticosteroids
    • cimetidine
  37. things that cause pseudodementia depression
    • self neglect
    • insomnia
    • anhedonia
    • lack of effort on mmse
Card Set
Geriatrics Dementias
PT I exam