Treatment and Management of Dementia Patients
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| **ADRD = Alzheimer Dementias/Related Dementias** |
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| ADRD care ? | * usu family/med staff at homes.... be empathetic to givers, bc there is a lot of turnover bc of burnout from stress from taking care of pts.... get care giver burden- can have neg outcomes for giver and pt
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| For caregivers , what do we screen ? | * Caregivers Burden Inventory... CBI... *ask about their depression and if they have thoughts of harming themselves/ADRD pt
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| Some developmental issues with ADRD pts and caregivers ? | * suffering social life, emotionally drained, retired and now have to fully assist spouse
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| Physical Sx ? | * no sleep, bad health, emotionally drained
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| Social Sx ? | * resentful of relatives who don't help out, stop hanging out w/ friends, family relationships suffer
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| What to do to help w/ Caregiver Stress ? | * praise their efforts and just communicate with them
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| Top thing to do when managing ADRD pts ? | * Educate them
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| Meds for Alzheimers ? | * Cholinesterase inhibitors
---Aricept (donepezil)
-Aricept ER
-Exelon (rivastigmine): pills or patches
-Razadyne (galantamine)
..........**NMDA inhibitors---
-Namenda (memantine)
-Namenda ER
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| Why is Aricept (generic for Donepezil) popular ? | * bc only dosed once a day
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| Dosing Considerations ? | * CrCl in every drug except Donepezil
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| Alternative non Pharmacologic ? | * Vit E - shown to preserve ADLs, no to stop dementia decline...... *Axona (medical food) - keeps pt in a ketotic state
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| Mgt of medical issue w/ ADRD | * can have low compliance, but need managed.... * Watch for ADRD drugs to exacerbate other medical issues (150/90 bp is ok)
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| What to do if caretaker said the ADRD pt is acting weird all of a sudden/ out of the norm ? | * get a UA - bc issues are harder to find in demented pts bc they can't remember whats going on
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| Geriatric Dementia and Depression ? | * screen for both, bc they can overlap and lead in to one another
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| If ADRD with Depression tmt ? | * SSRIs, lose dose and bump up..... NO TCAs...* trazadone or mirtazipine if sleep issues
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| Disturbance of consciousness with reduced ability to focus, sustain, or shift attention and Disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day ? | * Delirium
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| Delirium Consequences ? | * falls/fractures/illnesses, etc... Anesthesia can send a geriatric pt into a delirious state
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| Causes of Delirium ? | *D - drugs, E - electrolytes, L - lack of drugs/withdrawal, I - infct, R - reduced sensory input, I - intercranial issues (bd/stroke), U - urinary infct/retention/fecal impaction, M - MI issues
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| Delirium mgt ? | * non-pharm 1st !.... * quetiapine is DOC
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| Treatment of Lewy Body ? | * Avoid antipsychotics and AVOID Razadyne (galantimine) - cause death !!! ---- * use approved ACh esterase inhibitor drugs or add memantine
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| Behavioral and Psychological Symptoms of Dementia (BPSD) ? | * wandering, anger, avoid changing house stuff bc causes confusion, psychosis issues, depression, sleep issues,
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| BPSD mgt ? | * educate caregivers/pt, safe environments, avoid tasks they can not do, ask ?s bc pt can't remember drug adverse RXns etc.... *
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| BPSD drugs ? | *antipsychotics if psychosis, SSRIs if depressed, Anxious/Angry think Benzos, for apathy use stimulants
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| Sudden onset of Laughing or Crying ? | * Pseudobulbar Affect (PBA)----Occur out of proportion or incongruent to the underlying emotional state....... *FDA Tmt drug = Nuedextra
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| Medication Safety and ADRD ? | * only add meds if you have to and watch for adverse effects since pt can't remember them
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| Transitions of Care and ADRD ? | * getting the person with ADRD back home is the very best thing you can do.... * make care comfortable bc Alz is a terminal disease
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| Feeding tubes in end of life care ? | * NOT shown at all to help...do not use
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| EOLC of Symptoms ? | * More sensitive to narcotics – reg time control dose is best, but often respond to RTC acetaminophen
-----* Narcotics if necessary, but use RTC regimens, remembering that patients will not be able to ask
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| Possible preventive measures of ADRD ? | * healthy lifestyle, Mediterranean Diet - high olive oils, keep mind active, Avoid Modern Anti persperants “ Aluminum Chlorhydrate” – can cause dementias
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