Dementia - Campbell

What are the criteria for MILD neurocognitive disorders

• modest decline form a previous level of performance

• Does not interfere with independence

What are the criteria for MAJOR neurocognitive disorders

• Significant decline from a previous level of performance

• Cognitive deficits interfere with independence

What are the most frequent drug classes to induce cognitive decline

• skeletal Muscle Relaxants

• Tricyclic antidepressants

• Bladder antispasmodics

• Antihistamines

Cholinesterase Inhibitors for Dementia

• Donepezil

• Rivastigmine

• Galantamine

NMDA receptor antagonists for dementia

• Memantine

• Donepezil/ Memantine

Which drug class is FDA-approved in moderate to sever dementia only

NMDA receptor antagonist

Starting dose for Donepezil

5mg PO QD

Side effects of Donepezil

• GI Bleeding

• N/V/D

• insomnia

Starting dose for galantamine

4mg BID x 4 weeks

side effect of galantamine

• GI bleeding

• N/V/D

• weight loss

• Insomnia

Starting dose of Rivastigmine

1.5mg BID x 2 weeks

(take with food to decrease GI side effects)

Side effects of Rivastigmine

toxicity due to not removing previous patch QD

(N/V/D)

Starting dose of memantine

5mg QD x 1 weeks

Side effects for Memantine

• caution in seizure patients

• hallucinations/ confusion

• use with caution with carbonic anhydrase inhibitors and sodium bicarbonate

If you are on donepezil 10mg what dose of Namzaric should you start

7/10 QD

If you are on memantine 10mg what dose of Namzaric should you start

28/10 QD

Side effects of Namzaric

• bradycardia/ heart attack

• GI ulceration

• N/D/V

  • bladder outflow obstructions

What is required to start treatment of ‘mabs’

requires presence of amyloid beta pathology prior to initiating treatment

what are the monoclonal therapies for dementia

• Aducanumab

• Lecanemab

Side effects for Aducanumab

ARIA: up to 40%

(require MRI before 7^th and 12^th dose)

Side effects of lecanemab

ARIA: up to 30%

(require MRI before 5^th and 7^th and 14^th dose)

What is the most important behavioral interventions

Redirect and refocus/ reminiscence therapy

Agitation interventions for dementia patient

introduce distraction techniques

What treatment of psychosis has a boxed warning for increased risk of death or stroke in older adults with dementia

antipsychotics

What is a recommended treatment in Vascular dementia

Cholinesterase inhibitors

What is a recommended treatment in Lewy Body dementia

Cholinesterase inhibitors and memantine