Health Professional Guide to Memory Loss: Neurodegenerative Dementias

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Neurodegenerative dementias

Alzheimer’s disease is the most common neurodegenerative dementia. This category also includes frontotemporal and Lewy Body dementias.

 

Alzheimer’s Disease (AD)

Alzheimer’s Disease is marked by progressive memory impairment, gradually accompanied by cognitive impairment not caused by physical symptoms.

Characteristics of Alzheimer's Disease

  • Memory impairment with 1 or more cognitive deficits:
    • Executive dysfunction
    • apraxia
    • aphasia
    • agnosia
  • Subtle onset with progressive deterioration

Alzheimer’s Disease

Mild

Moderate

Severe

Characteristics

MMSE score 15 - 24

MMSE score 10 - 15

MMSE Score below 10

Recommendations

Report diagnosis

Refer to Alzheimer’s Society

Training and support for caregivers

Evaluate driving ability

Medical/legal issues

Refer to Alzheimer’s Society

Training and support for caregivers

Non-RX approach to physiological and behavioural symptoms of dementia

 

Institute plans for long-term care

Treatment Options

Prevention and treatment of vascular risk factors

ginkgo biloba: insufficient data

cholinergic replacement (donepezil, rivastigmine, galantamine)

Antipsychotics as needed

Warning ! Vitamin E is not recommended – high levels could cause death.

Cholinergic replacement (Donepezil, Rivastigmine, Galantamine)

Memantine

Antipsychotics as needed

 

Memantine

Cholinergic replacement

Limit prescriptions

Stop medications

 

Lewy Body Dementia and Frontotemporal Dementia

 

Lewy Body Dementia

Frontotemporal Dementia

Characteristics

Visual hallucinations (detailed/recurrent)

Highly variable cognitive status

Parkinsonian signs (esp. rigidity) / bradykinesia

Executive memory highly affected

Sensitivity to tranquilizers

Falls/unexpected loss of consciousness

Sleep problems

Relatively young onset (50 to 70 years old)

Behavioral changes: disinhibition/apathy/neglecting personal care/social misconduct

Impulsivity / poor judgment / irritability

Talks too much / behavioral perseveration

Executive function altered

Recommendations

Therapeutic trial of Rivastigmine, Galantamine and Donepezil

 

Behavioural interventions (calm and secure environment)

Treatment Alternatives

Rivastigmine.

 

Consider a monitored drug trial of one of the three medications in use and check if behaviour improves. BEWARE! anticholinergics can aggravate behavioural problems. Experts recommend a serotoninergic approach: SSRI or Trazodone.

 

Next: Vascular Dementia and Mixed Dementias

 

We are pleased to house this series of FAQs for health professionals, supervised by Cara Tannenbaum, from the Centre de recherche de l’Institut universitaire de gériatrie de Montréal.

Browse Contents of the Health Professional Guide to Memory Loss:

 

 

 

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