Alzheimers Disease

What is the most common type of dementia?

Alzheimers

What is the hallmark event in neurodegenerative disease ?

• Misfolding , aggregation and accumulation of proteins

What protein is affected in Alzheimers ?

• Hyperphosphorylated tau

What are the 4 main pharmacological interventions of Alzheimers?

• Donepezil

• Galantamine

• Rivastigmine

• Memantine

What drug class does donepezil, galantamine and rivastigmine belong to?

Acetylcholinesterase inhibitors

What drug class does memantine belong to?

NMDA receptor antagonist

What should you offer for mild-moderate dementia with Lewy bodies?

• Donepezil

or

• Rivastigmine

What should you only consider for mild-moderate dementia with Lewy bodies if donepezil and rivastigmine are not tolerated?

Galantamine

What should you offer for severe dementia with Lewy bodies?

• Donepezil

or

• Rivastigmine

What should you consider for people with dementia with Lewy bodies if AChE inhibitors are not tolerated/contraindicated ?

Memantine

What should you consider for people with vascular dementia if they have suspected comorbid Alzheimer's disease, Parkinson's disease dementia or dementia with Lewy bodies?

• AChE inhibitors

• Memantine

How is treatment initiated ?

• On advice by a clinician who has the necessary knowledge and skills.

• Once a decision has been made, the first prescription may be made in primary care

Should you stop AChE inhibitors in people with Alzheimers Disease based of disease severity alone?

• NO

How is non-cognitive symptoms, agitation, aggression, distress and psychosis managed?

• Conduct structured assessment to explore and addres reasons for their distress , which could be clinical or environmental

When should you offer antipsychotics ?

• For people living with dementia who are either: at risk of harming themselves or others

OR

• Experiencing agitation, hallucinations or delusions that are causing them severe distress.

What should you be considering when offering antipsychotics?

Use the lowest effective dose for the shortest duration

• Reassess at least every 6 weeks

What medication should not be prescribed to people with mild – moderate non-cognitive symptoms?

• Antipsychotics - Increased risk of stroke and death

What medication should not be offered to manage agitation or aggression in people living with dementia?

Valproate

What non pharma interventions to promote cognition independence and wellbeing?

• Group cognitive stimulation therapy

• Group reminiscence therapy

• Cognitive rehabilitation/occupational therapy

List 10 drugs that should be avoided cause they confusion

• Antiparkinsonian drugs

• Barbiturates

• Benzodiazepines

• Cimetidine

• Diuretics (dehydration)

• Hypoglycaemic agents

• Monoamine oxidase inhibitors

• Opioids

• Steroids

• Tricyclic antidepressants

List the 6 anticholinergic drugs with 1 point to the anticholinergic burden

• Haloperidol

• Quetiapine

• Mirtazapine

• Paroxetine

• Trazodone

• Ranitidine

List the 8 anticholinergic drugs with 2 point o the anticholinergic burden

• Cloazpine

• Nortiptyline

• Baclofen

• Cetirizine

• Loratidine

• Cimetidine

• Loperamide

• Prochlorperazine

List the 6 anticholinergic drugs with 3 point o the anticholinergic burden

• Chlorpromazine

• Amitriptyline

• Imipramine

• Chlorphenamine

• Hydroxyzine

• Oxybutynin