what are the investigations? dementia: investigations history taking clinical examination...
Post on 12-Jan-2016
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• What are the investigations?
Dementia: Investigations
• History taking
• Clinical examination• Neuropsychological assessment: -Episodic or short term memoryLanguage, particularly word fluencyExecutive functioning
Dementia: investigations
• Laboratory assessment:- Full blood count ESR Thyroid function test Serum electrolytes and calcium Serum glucose Serum BUN/creatinine B12 and folate Liver function test Syphilis serology HIV serology
Dementia: Investigations
• Medical imagingX- Rays, ECGCT or MRI scan of the brain
• How do you want to manage this patient?
Dementia of Alzheimer’s type
• Treat the cognitive deficits
• Treat the neuropsychiatric symptoms
Neurotransmitter system altered in Alzheimer’s disease
• Decreased
• Acetylcholine• Serotonin• Noradrenaline• Dopamine• GABA• Somatostatin• Vasopressin• Substance P• Neuropeptide Y
• Increased
• Monoamineoxidase B
• galanin
Neurotransmitter systems altered in Alzheimer’s disease
• Ach
Major neurotransmitter for memorySeverely affected in Alzheimer’s diseaseAcetylcholinesterase destroys Ach in the
brain to control amount of AchPossible to block this enzyme
Drug therapy in cognitive deficits• Mode of action
• Acetylcholinesterase inhibition
• Precursors loading• Neurotransmitter release
• Muscarinic agonists
• Examples
• Tacrine, donepezil, ENA 713, metrifonate, galanthamine
• Choline, lecithin• Besipiridine
• Milameline, xanomeline
Acetylcholinesterase inhibitors registered in Australia
• Donezepil (Aricept)
• Rivastigmine (Exelon)
• Galatamine (Reminyl)
• S/e – diarrhoea, nausea, vomiting, muscle cramps, insomnia, fatigue, and loss of appetite
precursorsAc CoA + choline
Ach
Ach
NM2
Increase release
Choline + acetate
Cholinesterase inhibitors
M1
Selective M1 agonists
Site of action of cholinergic
agonists
Drug therapy in neuropsychiatric symptoms
• Indications:
Mood, usually depression, rarely maniaPerception with hallucinations and
misindentificationsThought content with delusions and paranoid ideasBehaviour, with aggressions, wandering, sexual
disinhibition
Drug therapy in neuropsychiatric symptoms
• Neuroleptic
Indications – agitation, aggression, delusions and hallucinations
Haloperidol, olanzepine, thioridazine and risperidone
S/e – extrapyramidal, decreased cognitive performance
• Antidepressants
Selective serotonin uptake inhibitors (eg: sertraline)
Atypical antidepressants (trazodone)
Monoamineoxidase inhibitors (moclobemide, selegiline)
Treatment of vascular dementia
• Drug therapyAntiplatelet therapy (e.g aspirin 75 –
325mg)Other antiplatelet agent (e.g ticlopidine)
• SurgicalCarotid endarterectomy
Non drug treatment
• Better information for carers
• Reinforcement of day and time given regularly
• Behaviour modification
• Patient and family support
• Role of GP
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