Geriatrics and Dementia Chapter 28 Paauw
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- What are the 4 most common causes of dementia in older adults?
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1. Alzheimer's disease (2/3)
2. multi-infarct dementia (15%-25%) aka vascular dementia
3. Lewy body dementia (10%-20%)
4. Alcohol (10%) - What are the two most common causes of "reversible dementia"?
- drugs and depression ("pseudodementia") are by far the most common reversible causes
- What are some of the other causes of "reversible dementia" or cognitive impairment?
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1. B12 deficiency
2. hypothyroidism
3. normal pressure hydrocephalus - How do you establish the diagnosis of dementia?
- Do the mini-mental status examination (MMSE)
- What is the appropriate work-up for a patient suspected of having dementia?
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1. Perform a thorough H&P with focus on neurologic and mental status
2. Get a CBC, electrolytes, BUN, creatinine, LFTs, vit B12, thyroid screen, syphilis serology
3. Get a noncontrast CT to rule out tumor, subdural hematoma or hydrocephalaus. Brain imaging is absolutely indicated for patients with focal nuerologic signs, HA or other atypical features - What red flags increase the likelihood of a diagnosis other than Alzheimer's disease?
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1. Sudden onset: history of rapid cognitive decline over weeks to months rather than years
2. Onset at a younger age (under 60)
3. Presence of focal neurologic signs or symptoms - What pharmacologic treatments are available to patients with Alzheimer's dementia?
- Three cholinesterase inhibitors (donezepil, rivastigmine and galantamine); vitamine E and ginkgo biloba.
- What are the names of the three cholinesterase inhibitors used to treat Alzheimer's disease?
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1. donezepil
2. rivastigmine
3. galantamine - What are the main effects of the cholinesterase inhibitors in the treatment of Alzheimer's?
- They can significantly improve cognition, behavior and overall function. Their main effect appears to be to slow rates of decline.
- What are the two vitamins/supplements used to treat Alzheimer's?
- Vitamin E and ginkgo biloba.
- How do you manage common behavior problems such as agitation and sleep problems?
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seek out and address ...
1. medication side effects
2. infection
3. pain
4. exacerbation of preexisting illness
5. inconsistency in the environment that may be causing agitation
6. low dose neuroleptics such as haloperidol 0.5 mg, risperidone 0.5 mg or olanzapine 2.5 mg) may be helpful for severe agitation, persistent hallucinations or delusions.
7. Trazodone may be useful for sleep problems.