Geriatric Psychiatry: Dementia and Treatments

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Questions and Answers

What role do anti-depressants play in relation to dementia?

They may delay or stop the progression from MCI to Alzheimer's disease. (correct)

They increase the likelihood of developing Alzheimer's disease.

They worsen symptoms of dementia.

They have no effect on dementia progression.

Which of the following is identified as a significant target for the prevention of dementia?

Depression (correct)

Post-traumatic stress disorder

Schizophrenia

Anxiety disorders

Which pharmacological treatment option is mentioned as having potential benefits for dementia patients?

Glutamate receptor antagonists like memantine (correct)

Antipsychotic medications

Selective serotonin reuptake inhibitors (SSRIs)

Benzodiazepines

What is the focus of the lecture titled 'THE 3 D’S OF GERIATRIC PSYCHIATRY'?

Delirium, Depression, Dementia Signup and view all the answers

What concept is highlighted as a reason for using anti-depressants in Alzheimer’s treatment?

Depression exacerbates memory loss. Signup and view all the answers

What is the primary role of acetylcholine in the brain related to Alzheimer's disease?

It generates action potentials. Signup and view all the answers

Which of the following accurately describes the function of cholinesterase inhibitors?

They increase the concentration of acetylcholine in the system. Signup and view all the answers

What is a potential consequence of cholinergic neuron loss in Alzheimer's disease?

Decreased levels of acetylcholine. Signup and view all the answers

Which of the following options is a consideration when discussing dementia treatment?

Non-pharmacologic interventions are important. Signup and view all the answers

Which drug is categorized as a cholinesterase inhibitor for Alzheimer's disease?

Donepezil Signup and view all the answers

In which part of the lecture was the topic of the links between depression and dementia addressed?

Future Directions Signup and view all the answers

Which of the following responses indicates a positive emotional state in the BTFQ-D questionnaire?

I’m a good person Signup and view all the answers

What is a notable feature of non-pharmacologic interventions in dementia treatment?

They can improve quality of life. Signup and view all the answers

What is the correct response for 'I hope this works out' in the BTFQ-D questionnaire?

True Signup and view all the answers

What is the significance of allowing acetylcholine to remain active longer in Alzheimer's treatment?

It enhances memory and communication between neurons. Signup and view all the answers

Which pharmaceutical intervention targets the production or disruption of TAU protein in Alzheimer's disease?

Target TAU protein Signup and view all the answers

Which activity is not associated with a positive response in the BTFQ-D questionnaire?

Sad Signup and view all the answers

Which response corresponds to feeling uncertain according to the BTFQ-D?

I don’t know what to do for the best Signup and view all the answers

What is the primary focus of the cholinergic hypothesis in Alzheimer's disease?

Deficit in ACh signaling Signup and view all the answers

Which of the following is not a FDA-approved cholinesterase inhibitor for Alzheimer's therapy?

Tacrine Signup and view all the answers

In the BTFQ-D questionnaire, what does a response of 'B' represent?

Something you do Signup and view all the answers

Which one of the following is considered a treatment option in the summary?

Acetylcholine Inhibitors Signup and view all the answers

What is a common mechanism by which cholinesterase inhibitors work to aid cognitive function in Alzheimer's disease?

Inhibit ACh breakdown Signup and view all the answers

Which of the following statements about cholinergic therapy is true?

It has been effective in randomized controlled trials Signup and view all the answers

Which response indicates a negative emotional state according to the BTFQ-D questionnaire?

Angry Signup and view all the answers

What does 'T' signify in the BTFQ-D questionnaire responses?

Something you feel Signup and view all the answers

In the context of Alzheimer's disease, which neurotransmitter is primarily associated with attention, memory, and learning?

Acetylcholine Signup and view all the answers

What was a significant reason for the removal of Tacrine from the US market?

Severe hepatic toxicity Signup and view all the answers

Which type of intervention does NOT fall under the pharmaceutical strategies for Alzheimer's as discussed?

Increasing serotonin production Signup and view all the answers

What type of drug is typically prescribed for individuals who exhibit overeating and compulsive behaviors?

Selective Serotonin Reuptake Inhibitors Signup and view all the answers

Which drug is mentioned as an example of an anti-psychotic medication?

Olanzapine Signup and view all the answers

What is the primary role of Acetylcholine Inhibitors in treating dementia?

Enhance cholinergic function Signup and view all the answers

Which drug is used to treat REM sleep behavior disorder in Dementia with Lewy Bodies?

Clonazepam Signup and view all the answers

Which of the following medications is primarily used to deal with life-threatening behavioral problems?

Haloperidol Signup and view all the answers

In addition to SSRIs, which class of drugs is used for depression in patients with dementia?

Anti-depressants Signup and view all the answers

What is the function of memantine in dementia treatment?

Glutamate modulation Signup and view all the answers

Which of the following statements is true regarding medications for dementia with Lewy Bodies?

They are all the same as those for Alzheimer's Disease. Signup and view all the answers

What is the primary conclusion regarding pharmacological interventions for dementia?

They have minimal effectiveness in altering the time-course of disease progression. Signup and view all the answers

Which non-drug based treatment has the most supporting evidence for early-stage dementia?

Physical exercise. Signup and view all the answers

What is a significant limitation identified in research on non-pharmacologic interventions for dementia?

A significant lack of high-quality studies and RCTs. Signup and view all the answers

How can Cognitive Behavioral Therapy (CBT) benefit individuals with dementia?

It addresses symptoms of depression and anxiety. Signup and view all the answers

What kind of improvement is measured by the standardized mini mental state examination (SMMSE) in relation to dementia?

Modest cognitive improvement. Signup and view all the answers

Which of the following areas needs further validation and evidence in the context of dementia treatments?

Assistive technologies. Signup and view all the answers

What does cognitive rehabilitation primarily focus on?

Restoring cognitive functions. Signup and view all the answers

Which statement best describes the effectiveness of anti-dementia medication?

It minimally alters the progression of dementia. Signup and view all the answers

Study Notes

Lecture 8 - Dementia Treatment

Lecture is on dementia treatment
Presented by the School of Psychology, University of Leeds
The lecture will cover a range of topics related to dementia treatment, including pharmacological and non-pharmacological interventions.
It will mention the links between depression and dementia

Lecture Outline

Lecture 1: Introduction to Aging and Dementia
Lecture 2: Biological Aging
Lecture 3: Cognitive Aging
Lecture 4: Neurophysiological and Psychosocial Ageing
Lecture 5: Talking about Healthy Ageing (MCI - Diagnosis / Research)
Lecture 6: MCI - Treatment
Lecture 7: Dementia – Diagnosis / Research
Lecture 8: Dementia – Treatment
Lecture 9: Talking about Dementia discussion
Lecture 10: Living with Dementia
Lecture 11: Dementia Friendly, Revision, Feedback and Reflection

Overview of Today's Lecture (Part One)

Part One: Dementia Treatment
Pharmacologic Interventions:
- Cholinesterase
- Memantine
Non-pharmacologic interventions
Part Two: Treatment considerations
- Links between Depression and Dementia
- Future Directions

Part One: Dementia Treatment (Pharmacologic and Non-Pharmacologic)

Focuses on pharmacological and non-pharmacological interventions and their mechanisms of action in dementia treatment.

Drug-Based Treatment for Alzheimer's Disease

Discusses drug-based treatments specifically for Alzheimer's disease.

Acetylcholine Inhibitors (AChE)

Acetylcholine (ACh) is a neurotransmitter crucial for brain function
Acetylcholinesterase (AChE) breaks down acetylcholine in the synapse, reducing its activity
Cholinesterase inhibitors prevent ACh breakdown, leading to higher ACh concentrations and improved neuron signaling.
Lost cholinergic neurons reduce acetylcholine in the system.
Includes Donepezil, galantamine, and rivastigmine. Tacrine was previously used but taken off the market.

Possible Pharmaceutical Interventions for Alzheimer's Disease

Target TAU protein production/disruption: Prevent abnormal tau protein buildup, a key contributor to Alzheimer's pathology.
Target Amyloid beta accumulation and plaque formation: Prevent the buildup of amyloid-beta plaques, another central feature of Alzheimer's.
Increase ACh production: Boost production to enhance neurotransmitter function.

Cholinergic Hypothesis in Alzheimer's Disease (AD)

ACh is crucial for attention, memory, and learning
Deficient ACh is a hallmark of Alzheimer's
Lack of ACh prevents proper neuronal transmission

Cholinesterase Inhibitors (Therapy)

Donepezil, galantamine, and rivastigmine are FDA-approved cholinesterase inhibitors used in dementia treatment
Tacrine, the first approved cholinesterase inhibitor, was removed from the US market due to liver toxicity.

Memantine

A different type of treatment, a NMDA receptor antagonist in Alzheimer's disease
It aims to reduce excess glutamate effects that damage the brain.

Treatment for Vascular Dementia (VtD)

Life expectancy is roughly 5 years post-diagnosis
Daily Aspirin/Clopidogrel to reduce blood clots and anticoagulant medicine
High blood pressure and diabetes medication for associated risk factors.

Treatment for Frontotemporal Dementia (FTD)

FTD affects mood and behavior.
Treatments address underlying issues like overeating, compulsive behaviours, and hallucinations.
SSRIs (selective serotonin reuptake inhibitors) are commonly used for mood disorders
Antipsychotics can be used for some patients.

Treatment for Dementia with Lewy Bodies (DLB)

Similar drug treatments to Alzheimer's disease

Further Treatments for Dementia with Lewy Bodies (DLB)

Levodopa to replace dopamine
Antidepressants (SSRIs) to increase serotonin
Medications to address movement problems, REM sleep disorders, depression, anxiety

Interactive Task

Considering pros and cons of pharmacological interventions
Side effects, costs, effectiveness, quality of life, and adherence are discussed

Pharmacologic Interventions for Dementia

Shows a modest improvement in dementia patients using standardized mini-mental state examination (SMMSE) and Bristol Activities of Daily Living (BADLS).

Anti-dementia medication and its impact

Minimal effectiveness in altering disease progression, requiring more rationale for use.

Non-drug Based Treatments for Alzheimer's Disease

Cognitive stimulation is a supportive treatment
Physical exercise is also beneficial, especially in early-stage dementia
Quality studies on non-pharmacological interventions are lacking

Cognitive Therapy

Techniques such as cognitive stimulation, rehabilitation, and training can help with cognitive function.
Cognitive behavioural therapy (CBT) addresses symptoms of depression and anxiety

Behavior Questionnaire

A questionnaire to assess thoughts, feelings, and behaviours in individuals with dementia.

Comparison of BFT Questionnaire Results

Comparing results from different questionnaires for people with and without dementia

Summary of Treatment Options

Summarizes options of pharmacological and non-pharmacological treatments for different types of dementia

Depression and Dementia

Depression has been linked with dementia in research
Depression often shows up early (before diagnosis) as an indication of potential cognitive decline.
Potential for depression as both a cause and a consequence of or symptom of cognitive decline

Possible Mechanisms Linking Depression and Dementia

Explains the possible mechanisms (e.g., HPA axis dysregulation, neuroinflammation, neurotransmitter imbalance) linking the two
Discusses nerve growth factors impacted in these scenarios

Neurotransmitter Dysfunction and Depression Effects on AD Pathology

Describes how neurotransmitter imbalances and neural inflammation can affect the onset of Alzheimer's disease pathology.

Summary of Depression Effects on Alzheimer's Disease

Neurotransmitter imbalance, HPA-axis dysregulation, nerve growth factors, and their roles in the development of the disease pathology

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Description

This quiz explores the interplay between anti-depressants and dementia, particularly in the context of geriatric psychiatry. It covers treatment options, the role of acetylcholine, and the impact of cholinesterase inhibitors. Test your knowledge on these vital topics affecting elderly mental health.