Aging Beautifully Part 3: Dementia

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  • Today I will discuss Urinary Incontinence, the 2nd part of the Aging beautifully series.
  • Reversible cause of mental status change: alcohol abuse, thyroid dysfunction, dehydration and electrolyte disturbance, infection, vit b12 deficiency, medications: anticholinergics (for overactive bladder, tiotropium for asthma
  • IADLS (laundry, housekeeping, managing meds, may get lost in familiar places)
  • AP can enhancetherapietic
  • AP can enhancetherapietic
  • AP can enhancetherapietic
  • AP can enhancetherapietic
  • Pharmacists, we have a role to play… As patient advocates and front-line health care professionals we can educate, recommend better treatment alternatives, ensure their safety, and listen… so someday, our patients can say…


  • 1. You have 9 seconds left…Let’s Play!
  • 2. Which color is missing??
  • 3. Guess who’s who?Let’s Play!
  • 4. Impressive!Scoreboard:• Dr. A• Dr. G• Dr. S• Dr. T
  • 5. By the way,what istoday’s date?
  • 6. Memory ispowerful.but not untilwe lose it thatwe fully realizeits significance
  • 7. AgingBeautifully:Visions & RealitiesPart III: Dementia Christine HortillosaPharm.D. 2013 CandidateUniversity of Texas at Austin College of Pharmacy5. 9. 2013
  • 8. DeliriumDementiaAcuteTwo of the following:•Misinterpretation, illusions, hallucinations•Incoherent speech•Disturbance in sleep-wake cycle•Change in psychomotor activityRelated to medical illness + medicationsReversibleProgressiveMarked by memory impairmentNot a normal part of agingIrreversible
  • 9. Most common formof dementia is…Alzheimer’sdisease
  • 10. mildmoderatesevere20-24Short-term memory loss;word-finding problemsLoss of IADLs10-19Disorientation to time, place,inability to engage in activitiesNeeds assistance with ADLs<10Loss of speech andambulation, incontinence of boweland bladderDependency in basic ADLs; often requiresaround-the-clock care*ADLS= activities of daily living (bathing, dressing); IADLS=instrumental activities of daily living (housekeeping); MMSE=Mini-Mental Status ExaminationMMSE Examples of cognitive lossExamples of functional lossStages
  • 11. Drugs for Treatmentof Alzheimer’sDonepezilRivastigmineGalantamineMemantine
  • 12. DonepezilStarting Dose 5 mg/day; No dose change for renalimpairmentMaintenance Dose 10mg/dayMay also increase to 23mg/dayProperties Cholinesterase inh; partly metabolizedby CYP 2D6 and 3A4Indication For all stages of Alzheimer’sAdverse Effects Bradycardia, syncope, weight loss,N/V/D, InsomniaDDI Anticholinergics, Antipsychotics, Beta-blockers, AlcoholAdministration At bedtime without regard to food
  • 13. Starting Dose 1.5mg BID; No dosage change forrenal impairmentMaintenance Dose 3-6mg BIDProperties Cholinesterase inhIndication For mild to moderate Alzheimer’s andmild-to moderate dementia withParkinson’sAdverse Effects Has most intense cholinergic (N/V/D)ADE, bradycardia, syncope, dizziness,EPSDDI Anticholinergics, Antipsychotics, Beta-blockers, AlcoholAdministration With meals; for patch (avoid applicationto same spot for 14 days)Rivastigmine
  • 14. Starting Dose 4 mg BID; Use not reco’d for CrCl<9ml/minMaintenance Dose 8-12mg BID or 8-24mg ER QdayProperties Cholinesterase inh and nicotinereceptor modulator; partly metabolizedby CYP 2D6 and 3A4Indication For mild-to-moderate Alzheimer’sAdverse Effects Bradycardia, syncope, weight loss,N/V/DDDI Anticholinergics, Antipsychotics, Beta-blockers, AlcoholAdministration With meals; if therapy is interrupted for3+ days, restart at lower dose andincrease to current doseGalantamine
  • 15. MemantineStarting Dose 5 mg/day (max dose of 20mg for CrCl30-49 and max dose 5mg for CrCl 5-29)Maintenance Dose 10mg BIDProperties Blocks glutamate transmissionIndication For moderate to severe Alzheimers;may be used in combination withdonepezilAdverse Effects Hypertension, confusionDDI Sodium bicarbonate, TrimethoprimAdministration Without regard to food
  • 16. Start with cholinesterase inhibitorsCaution: statistically significant difference ≠ clinical meaningful improvement
  • 17. How long shouldthe therapy be?• Evaluation at 3-6 months for prevention ofdecline or improvement• Conflicting evidence in unresponsive patients• Taper upon discontinuation
  • 18. arecritical ineffectivealzheimer’sdiseasemanagement.
  • 19. With your help,I can preservemy memories alittle bit longer.
  • 20. Discussion.