Dementia Part 2

Question 1

individuals in this stage of dementia experience no memory problems, and nothing is evident to a health care professional during a medical interview

Answer 1

stage 1

no cognitive impairment

Question 2

individuals in this stage of dementia feel like they have memory lapses, esp in forgetting familiar words or names or the location of keys or other everyday objects. these problems are NOT evident during medical exam or apparent to friends or family.

Answer 2

stage 2

very mild cognitive decline

Question 3

in this stage of dementia, friends, family and coworkers begin to notice deficiencies. problems with memory or concentration MAY be measurable in clinical testing

Answer 3

stage 3

mild cognitive decline
early stage alzheimer’s can be diagnosed in some

Question 4

at this stage, a careful medical interview detects clear-cut deficiencies. the affected individual may seem subdued or withdrawn, especially in mentally or socially challenging situations

Answer 4

stage 4

moderate cognitive decline

mild or early-stage AD

Question 5

at this stage, major gaps in memory and deficits in cognitive function emerge. some assistance with day-to-day activities becomes essential

Answer 5

stage 5

moderately cognitive decline (moderate or mid-stage AD)

Question 6

at this stage, memory difficulties continue to worsen, significant personality changes may emerge, and affected individuals need extensive help with customary daily activities

Answer 6

stage 6

severe cognitive decline (mod-severe or mid-stage AD)

Question 7

at this stage, individuals lose the ability to respond to their environment, to speak, and ultimately control movement

Answer 7

stage 7

very severe cognitive decline (severe or late-stage AD)

Question 8

how often should a patient with AD be seen by a medical provider?

Answer 8

every 3-6 months

Question 9

what is our cholinesterase inhibitor used to manage alzheimers?

Answer 9

aricept (donepezil)

Question 10

is the use of aricept used in the following diseases?

1) vascular dementia
2) lewy body dementia
3) parkinson dementia
4) frontotemporal dementia

Answer 10

1) vascular = NO
2) lewy body = beneficial for behavioral disturbance
3) parkinson = rivastigmine for mild-moderate dementia (also chilinesterase inhibitor)
4) frontotemporal = NO and may WORSEN agitation

Question 11

what drug is considered neuroprotective and its effect is to reduce the glutamate-mediate excitotoxicity seen in treatment with aricept?

Answer 11

memantine

Question 12

has memantine shown modest benefit in cognition, ADLS, and behavior in AD?

Answer 12

yes

only give for moderate-severe AD

Question 13

what vitamin has been shown to maybe lower the rate of decline in AD, but has NO evidence of cognitive improvement in AD?

Answer 13

vitamin E

but i guess its not longer recommended = evidence of increased mortality with HD supplementation

Question 14

_______ may lower the rate of decline, but has no evidence of cognitive improvement of AD

Answer 14

selegiline

Question 15

your patient wants their mother to take gingko biloba because they saw it helps with AD. what do you tell them?

Answer 15

no benefit in slowing cognitive decline in MCI

Question 16

if your patient with dementia begins presenting with more and more behavioral disturbances, what must you attempt to do?

Answer 16

figure out what their unmet need is; investigate underlying medical or psych d/o that could be contributing

ie. repetitive vocalizations = they need help or attention

Question 17

you are working up your patient with dementia’s inappropriate behavior. what types of things should you look into/for?

Answer 17

Medications – new med? increased dose? med toxicity?

PE – infection? dehydration? constipation? medication toxicity?

Question 18

are pharm treatments or non-pharm treatments considered more beneficial in managing behavioral disturbances in dementia?

Answer 18

non-pharm

Question 19

what is the term for an acute, strong emotional reaction that occurs when patient’s with dementia are confronted with confusing or stressful situations?

Answer 19

catastrophic reactions

Question 20

what are some ways to manage physiologic triggers that could cause a behavioral disturbance in your dementia patient?

Answer 20

1) discontinue inappropriate med
2) avoid sensory impairment (glasses/hearing aids)
3) offer food/drink
4) provide physical activity
5) treat sx such as pain, constipation, urinary retention
6) evaluate and treat endocrine d/o (blood sugar, thyorid)
7) evaluate and treat infection

Question 21

what are some ways to manage environmental triggers that could cause a behavioral disturbance in your AD patient?

Answer 21

1) provide REGULAR, daily routine, activities, and structure
2) provide comfortable, familiar living environment
3) provide SAME caregiver if possible
4) engage patient in simple daily activities according to ability
5) avoid overstimulation
6) consider music therapy

Question 22

when conversing with your patient with AD, is it better to ask questions with a few choices or open-ended questions?

Answer 22

questions with a few choices

Question 23

you should avoid frequent corrections in a patient with AD, instead of saying “don’t do this,” you should instead say _____

Answer 23

please do this

Question 24

are behavioral disturbances best managed pharmacologically or non-pharmacologically?

Answer 24

non-pharmacologically

Question 25

if a patient with AD has depression that is lasting over 2 weeks, causing them significant distress, what should you consider?

Answer 25

a trial of an antidepressant should be strongly considered

Question 26

if depressive symptoms last over 2 months after behavioral interventions have been tried, what is warranted?

Answer 26

treatment with an antidepressant

Question 27

biggest SE we worry about with antidepressants?

Answer 27

falls and anticholinergic effects that may worsen confusion (ex. paroxetine)

Question 28

have antidepressants been shown to be effective for patients with sx of disinhibition and compulsive behaviors?

Answer 28

yes

Question 29

antidepressants may also be indicated for these 5 conditions

Answer 29

1) low appetite
2) insomnia
3) fatigue
4) irritability
5) agitation

Question 30

1st and2nd generation antipsychotics MAY be needed for psychosis and physical depression, but we want to do our best to avoid them because why?

Answer 30

black box warning of all-cause mortality in dementia

limited evidence of efficacy

really try to avoid

Question 31

what drugs can be used for manic symptoms? what do we worry about with these?

Answer 31

valproic aid and carbamazepine

possible options, but increased risk of mortality!

Question 32

these two drug classes should be AVOIDED in patients with dementia

Answer 32

benzodiazepines

anticholinergic medications