DementiaDiagTreat0208.pptVIP

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