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Aging Beautifully Part 3: Dementia


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Aging Beautifully Part 3: Dementia

  1. 1. You have 9 seconds left…Let’s Play!
  2. 2. Which color is missing??
  3. 3. Guess who’s who?Let’s Play!
  4. 4. Impressive!Scoreboard:• Dr. A• Dr. G• Dr. S• Dr. T
  5. 5. By the way,what istoday’s date?
  6. 6. Memory ispowerful.but not untilwe lose it thatwe fully realizeits significance
  7. 7. AgingBeautifully:Visions & RealitiesPart III: Dementia Christine HortillosaPharm.D. 2013 CandidateUniversity of Texas at Austin College of Pharmacy5. 9. 2013
  8. 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. 9. Most common formof dementia is…Alzheimer’sdisease
  10. 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. 11. Drugs for Treatmentof Alzheimer’sDonepezilRivastigmineGalantamineMemantine
  12. 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. 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. 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. 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. 16. Start with cholinesterase inhibitorsCaution: statistically significant difference ≠ clinical meaningful improvement
  17. 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. 18. arecritical ineffectivealzheimer’sdiseasemanagement.
  19. 19. With your help,I can preservemy memories alittle bit longer.
  20. 20. Discussion.