- 1、原创力文档(book118)网站文档一经付费(服务费),不意味着购买了该文档的版权,仅供个人/单位学习、研究之用,不得用于商业用途,未经授权,严禁复制、发行、汇编、翻译或者网络传播等,侵权必究。。
- 2、本站所有内容均由合作方或网友上传,本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺!文档内容仅供研究参考,付费前请自行鉴别。如您付费,意味着您自己接受本站规则且自行承担风险,本站不退款、不进行额外附加服务;查看《如何避免下载的几个坑》。如果您已付费下载过本站文档,您可以点击 这里二次下载。
- 3、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等,请点击“版权申诉”(推荐),也可以打举报电话:400-050-0827(电话支持时间:9:00-18:30)。
查看更多
DementiaDiagTreat讲述
Other Treatments Behavioral/agitation: Nonpharmacologic strategies Reasons for NH placement: Agitation Incontinence Falls Caregiver stress ?Antipsychotics NO data to support any significant benefit for treating behavioral symptoms of dementia with antipsychotic agents Small group of patients with active psychoses, disturbing hallucinations, or aggressive behaviors who may have some benefit Antipsychotics Side Effects: Sedation Anticholinergic effects Prolonged QT Edema Orthostasis Weight gain Confusion Warnings: FDA black box warning for increased mortality (OR 1.5–1.7), and increased ?increased stroke risk Antipsychotics NO if you suspect DLB Antipsychotics Risperidone (0.5 BID) Olanzepine (zyprexa): 2.5–5 mg/day Quetiapine (seroquel) Rapid titration, use in PD 12.5–200 mg/day Clozapine Use in PD (least risk of tremor) Agranulocytosis and limited use Ziprasidone (geodon) QT prolongation Prevention? HTN and DM linked to ALL types dementia Studies of treating systolic hypertension in the elderly (SHEPS and others): decreased risk of development of cognitive impairment in patients in treatment group Decreased risk included vascular AND Alzheimer type dementias Cholinesterase inhibitors seem to work as well (or as poorly) for both vascular and Alzheimer type of dementias What is the link? Both common, ?unmasking? ?Link with Hyperlipidemia Conflicting data Retrospective studies suggest decreased risk in those patients who are treated with statins PROSPER study 6000 patients age 70–80 with vascular risk factors given pravastatin or placebo 3 year: no effect on cognitive function ?Long enough follow up? Future Treating vascular risk factors to decrease development/unmasking of dementia? Actively seeking to differentiate different types of dementia, while also Recognizing significant OVERLAP of dementia etiologies in older patients Move toward agents other than cholinesterase inhibitors? Move away from broad use of antipsychotic agents DLB: Neuroleptic Hypersensitivity
文档评论(0)