delirium and dementia

delirium

disturbance in attention and cognition

in a short period of time/rapid onset

curable

neurocognitive disorders

alzheimer’s disease, frontotemporal degeneration, lewy body disease, vascular disease

hyperactive delirium

agitation, agression

delirium rating scales

CAM, DRS, MDAS

medications causing delirium

benzos, opioids, -dipines, antihistamines

delirium prevention

non pharm - daily movement, clock, lights, nutrition, hydration

consider melatonin, ramelteon, DORAs

delirium treatment

non pharm, ketamine for pain

avoid haloperidol and antipsych unless treating severe agitation/agression

dementia

significant, gradual cognitive decline, decrease in memory

dementia rating scales

ADAS, MMSE, MOCA

alzheimer’s disease

caused by amyloid beta plaques and abnormal tau protein

→ decreased ACh and excess glutamate

alzheimer’s treatment

therapy, rehab

AChEi, memantine

second line = combo

frontotemporal dementia

behavioral problems and decline in language/speech

frontotemporal and vascular dementia treatments

NOTHING

lewy body dementia

gradual progression with visual hallucinations and parkinsonism symptoms

causd by alpha synuclein protein

lewy body dementia treatment

therapy, rehab

donepezil, rivastigmine

second line = galantamine, memantine

antipsychotics in lewy dem

quetiapine, clozapine

vascular dementia

cognitive deficits caused stroke or brain bleed

dementia prevention

leafy greens, fish, bp and cholesterol control

exercise, brain games

acetylcholinesterase inhibitors

donepezil (ARICEPT tab, odt, patch)

galantamine (RAZADYNE cap, solution)

rivastigmine (EXELON cap, solution, patch)

AChEi mechanism

inhibits enzymes that breaks down ACh → increase ACh to improve memory and cognition

AChEi ade

GI bleed, anorexia (sudden weight loss)

NMDA antagonist

memantine (namenda)

caution in seizures

amyloid beta antibodies

lecanemab (leqembi)

donanemab (kisunla)

amyloid beta mab mechanism

target amyloid beta and decrease plaque

(controversial)

amyloid beta mab considerations

must confirm presence of plaques before starting

major ade = ARIA brain bleed and swelling

managing behavioral symptoms of dementia

antipsychotics → severe aggression, hallucinations (BBW increase mortality)

antidepressants → SSRI, paroxetine

brexpiprazole (rexulti)

FDA approved for agitation in alzheimer’s disease