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
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
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
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
Behavioral and PsychologicalSymptoms of Dementia (BPSD) Atypical anti-psychotics SSRI Carbamazepine Simple low-cost strategies to manage BPSD. Ex: massage, music and aroma therapy
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.
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.
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