Management & treatment of dementia

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Management & treatment of dementia

  1. 1. Management & Treatment ofDementia
  2. 2. Guiding principles Early diagnosis. Find out treatable causes Optimization of physical health, cognition activity and well being. Detection and treatment of BPSD. Educating care taker and providing long term support to care taker
  3. 3. DiagnosisInitial evaluation: Further tests as MRI of brain, possibly also indicated: CT  Lumbar puncture ESR, CRP  Antibodies: ANA, anti- complete blood count and dsDNA, smear  Intestinal biopsy, brain Na, K, Ca, glucose biopsy Serum electrophoresis  Urine screening for amino LFT acids and disorders of carbohydrate metabolism HIV, syphilis serology, Lyme, herpes  Genetic analysis simplex, and other serological test Thyroid function test Vitamin B12, folic acid
  4. 4. Imp Drugs Cholinesterase Inhibitors (ChEIs) donepezil, rivastigmine and galantamine. The NMDA receptor antagonists (memantine) Moderate to severe stages of AD and VaD Useful to improve cognitive function and behavioral symptoms
  5. 5. MOA, dose Rivastigmine – Inhibits AChE and BuChE, that predominates in brain, Dose: Intially 1.5mg BD, increases every 2 weeks by 1.5mg/day upto 6 mg/BD Donepezil – cerebroselective & reversible anti – AChE, Dose: 5mg OD HS Galantamine – natural alkaloid, anti – AChE, Dose: 4mg BD Memantine – NMDA receptor antagonist, appears to block excitotoxicity of glutamate, Dose: start with 5mg OD, increase upto 10mg BD, stop if no clinical benefit in 6 months
  6. 6. Misc Drugs Piractem, Pyritinol, Dihydroergotoxine.
  7. 7. Behavioral and PsychologicalSymptoms of Dementia (BPSD) Atypical anti-psychotics SSRI Carbamazepine Simple low-cost strategies to manage BPSD. Ex: massage, music and aroma therapy
  8. 8. Support for Care takers Psycho-educational interventions, many of which include an element of care taker training. Psychological therapies e.g. cognitive behavioral therapy (CBT), and counseling. Care taker support and care.
  9. 9. Evidence based Rx Partially effective treatments are available for most core symptoms of dementia. Symptomatic, but do not alter the progressive course of the disease. Importantly, psychological and psychosocial interventions (sometimes referred to as non-pharmacological interventions) may be as effective as drugs, but have been less extensively researched, and much less effectively promoted.
  10. 10. Modifiable risk factors Role of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) in the aetiology of dementia and AD. Smoking increases the risk of AD. Midlife hypertension and hypercholesterolemia are associated with AD onset in later life. Diabetes Atherosclerosis and AD are linked disease processes, with several common underlying factors (the APOE e4 gene, hypertension, increased fat intake and obesity, raised

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