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'?

<p>Delirium, Depression, Dementia (C)</p> Signup and view all the answers

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

<p>Depression exacerbates memory loss. (B)</p> Signup and view all the answers

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

<p>It generates action potentials. (D)</p> Signup and view all the answers

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

<p>They increase the concentration of acetylcholine in the system. (D)</p> Signup and view all the answers

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

<p>Decreased levels of acetylcholine. (B)</p> Signup and view all the answers

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

<p>Non-pharmacologic interventions are important. (B)</p> Signup and view all the answers

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

<p>Donepezil (D)</p> Signup and view all the answers

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

<p>Future Directions (D)</p> Signup and view all the answers

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

<p>I’m a good person (D)</p> Signup and view all the answers

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

<p>They can improve quality of life. (D)</p> Signup and view all the answers

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

<p>True (A)</p> Signup and view all the answers

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

<p>It enhances memory and communication between neurons. (D)</p> Signup and view all the answers

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

<p>Target TAU protein (A)</p> Signup and view all the answers

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

<p>Sad (D)</p> Signup and view all the answers

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

<p>I don’t know what to do for the best (C)</p> Signup and view all the answers

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

<p>Deficit in ACh signaling (A)</p> Signup and view all the answers

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

<p>Tacrine (C)</p> Signup and view all the answers

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

<p>Something you do (C)</p> Signup and view all the answers

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

<p>Acetylcholine Inhibitors (B)</p> Signup and view all the answers

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

<p>Inhibit ACh breakdown (C)</p> Signup and view all the answers

Which of the following statements about cholinergic therapy is true?

<p>It has been effective in randomized controlled trials (C)</p> Signup and view all the answers

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

<p>Angry (D)</p> Signup and view all the answers

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

<p>Something you feel (C)</p> Signup and view all the answers

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

<p>Acetylcholine (B)</p> Signup and view all the answers

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

<p>Severe hepatic toxicity (C)</p> Signup and view all the answers

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

<p>Increasing serotonin production (B)</p> Signup and view all the answers

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

<p>Selective Serotonin Reuptake Inhibitors (D)</p> Signup and view all the answers

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

<p>Olanzapine (C)</p> Signup and view all the answers

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

<p>Enhance cholinergic function (B)</p> Signup and view all the answers

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

<p>Clonazepam (B)</p> Signup and view all the answers

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

<p>Haloperidol (A)</p> Signup and view all the answers

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

<p>Anti-depressants (A)</p> Signup and view all the answers

What is the function of memantine in dementia treatment?

<p>Glutamate modulation (A)</p> Signup and view all the answers

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

<p>They are all the same as those for Alzheimer's Disease. (C)</p> Signup and view all the answers

What is the primary conclusion regarding pharmacological interventions for dementia?

<p>They have minimal effectiveness in altering the time-course of disease progression. (B)</p> Signup and view all the answers

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

<p>Physical exercise. (B)</p> Signup and view all the answers

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

<p>A significant lack of high-quality studies and RCTs. (D)</p> Signup and view all the answers

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

<p>It addresses symptoms of depression and anxiety. (A)</p> Signup and view all the answers

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

<p>Modest cognitive improvement. (A)</p> Signup and view all the answers

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

<p>Assistive technologies. (D)</p> Signup and view all the answers

What does cognitive rehabilitation primarily focus on?

<p>Restoring cognitive functions. (D)</p> Signup and view all the answers

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

<p>It minimally alters the progression of dementia. (A)</p> Signup and view all the answers

Flashcards

Acetylcholine (ACh)

A neurotransmitter abundant in the brain that plays a role in memory and learning.

Acetylcholinesterase (AChE)

An enzyme that breaks down acetylcholine in the brain, reducing its effectiveness.

Acetylcholine inhibitors

Drugs that inhibit the breakdown of acetylcholine by blocking AChE, increasing ACh levels in the brain.

Alzheimer's Disease (AD)

A type of dementia characterized by amyloid plaques and neurofibrillary tangles in the brain, leading to memory loss, cognitive decline, and behavioral changes.

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Synapse

The space between two neurons, where neurotransmitters are released to transmit signals.

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Action potential

The process of generating an electrical signal in a neuron, enabling communication within the nervous system.

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Cholinergic neurons

Neurons that use acetylcholine as their primary neurotransmitter.

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Cholinergic neurodegeneration

The loss of cholinergic neurons in Alzheimer's disease, leading to reduced acetylcholine levels in the brain.

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What is the TAU Protein?

A protein that accumulates in the brain and forms neurofibrillary tangles, contributing to Alzheimer's disease.

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What is Amyloid Beta?

A protein fragment that clumps together forming amyloid plaques in the brain, another hallmark of Alzheimer's disease.

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What is Acetylcholine (ACh)?

The primary neurotransmitter involved in memory, learning and attention. Its deficiency is a key factor in Alzheimer's disease.

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What is the Cholinergic Hypothesis of Alzheimer's?

A theory proposing that the primary cause of Alzheimer's is a deficit in Acetylcholine (ACh) production or function.

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What are Cholinesterase Inhibitors?

Drugs that inhibit the breakdown of Acetylcholine (ACh), increasing its availability in the brain.

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List three FDA-approved cholinesterase inhibitors.

Donepezil, Galantamine, and Rivastigmine are examples of FDA-approved cholinesterase inhibitors for Alzheimer's treatment.

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What major side effect led to the withdrawal of Tacrine?

A significant side effect of Tacrine, an early cholinesterase inhibitor, leading to its withdrawal from the market.

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How have the effects of cholinesterase inhibitors been proven?

Clinical trials have confirmed the efficacy of cholinesterase inhibitors in improving cognitive function in Alzheimer's patients.

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Depression

A mental state marked by persistent low mood, lack of interest, and feelings of sadness, often accompanied by physical symptoms like fatigue and sleep disturbances.

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Alzheimer's Disease

A type of dementia characterized by memory loss, cognitive decline, and behavioral changes, often caused by damage to brain cells.

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Antidepressants

A medication that aims to regulate the levels of neurotransmitters in the brain, potentially affecting mood and cognitive function.

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Frontotemporal Dementia (FTD)

A type of dementia that affects the frontal and temporal lobes of the brain, leading to behavioral and personality changes, including apathy, disinhibition, and executive dysfunction.

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Mild Cognitive Impairment (MCI)

A condition characterized by mild forgetfulness and cognitive decline, often viewed as a potential precursor to dementia.

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Geriatric Psychiatry

A type of treatment that focuses on understanding and managing mental health issues in older adults.

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NMDA blockers

A class of drugs that block the action of glutamate, a neurotransmitter involved in learning and memory, to potentially slow down cognitive decline.

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Dopamine

A neurotransmitter that plays a crucial role in movement, motivation, and reward.

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Levodopa

A medication used to replace dopamine in the brain, often used for treatment of Parkinson's disease and sometimes in dementia with Lewy Bodies.

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Dementia with Lewy Bodies (DLB)

A type of dementia characterized by the presence of Lewy bodies in brain cells, leading to symptoms like hallucinations, cognitive fluctuations, and movement problems.

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Selective Serotonin Reuptake Inhibitors (SSRIs)

A class of medications that target serotonin levels in the brain, commonly prescribed for depression.

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Anti-psychotic drugs

Medications used to manage psychosis and hallucinations, sometimes used in cases of dementia with severe behavioral problems.

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BTFQ-D

A questionnaire used to assess thought-feeling discrimination in people with dementia. It asks participants to identify whether a word represents an action, a feeling, or something they think.

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BTFQ

A questionnaire designed to assess the ability to distinguish between thoughts and feelings, originally used in non-dementia populations.

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Thought-feeling discrimination

The ability to differentiate between thoughts and feelings.

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Acetylcholine

A neurotransmitter that plays a crucial role in memory, learning, and other cognitive functions.

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Acetylcholinesterase

An enzyme that breaks down acetylcholine in the brain. Acetylcholine inhibitors work by blocking this enzyme, thereby increasing acetylcholine levels.

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Pharmacological options for dementia

Aspirin, blood pressure drugs, and other medications used in managing cardiovascular disease often have a positive effect on brain health and cognitive function.

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Non-pharmacological dementia treatment options

Non-pharmacological interventions for dementia include cognitive stimulation, exercise, music therapy, and social engagement. These therapies can help maintain cognitive function and improve quality of life.

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Pharmacological Interventions for Dementia

Pharmacological interventions are medications used to treat dementia, aiming to improve cognitive function, reduce symptoms, and slow disease progression. These interventions usually work by targeting neurotransmitters and modulating brain activity.

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Anti-Dementia Medication

Anti-dementia medications are a type of pharmacological intervention that aim to improve cognitive function and slow down dementia progression. These medications are often not a cure but can help manage symptoms and maintain quality of life.

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Limited Effectiveness of Anti-Dementia Medications

The effectiveness of anti-dementia medication in significantly delaying dementia progression is limited. While some medications can provide modest improvements in standardized tests, they don't drastically change the disease's time course.

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Non-Pharmacologic Interventions for Alzheimer's

Non-pharmacologic interventions for Alzheimer's disease are alternative therapies that focus on lifestyle modifications, behavioral interventions, and environmental support to improve quality of life and manage symptoms.

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Cognitive Stimulation for Dementia

Cognitive stimulation is a non-pharmacologic intervention that involves engaging individuals with dementia in mentally stimulating activities, such as puzzles, games, and social interactions, to maintain cognitive function and reduce cognitive decline.

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Physical Exercise for Dementia

Physical exercise, including walking, swimming, and strength training, is a crucial non-pharmacologic intervention for individuals with dementia, providing numerous physical and cognitive benefits.

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Cognitive Behavioural Therapy (CBT) for Dementia

Cognitive Behavioral Therapy (CBT) is a type of therapy used to address depression and anxiety in individuals with dementia. It helps them explore their emotions and develop strategies for managing challenging situations.

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Cognitive Restructuring

Cognitive restructuring is a component of CBT where individuals with Dementia learn to identify and challenge negative or distorted thoughts, replacing them with more realistic and positive perspectives.

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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

Other Important Topics

  • A brief mention of a new medicine Lecanemab (FDA 2023 Approved) that reduces amyloid-related decline
  • Covid-19 impact on mental health, including rise in depression and anxiety. The pandemic showed increased prevalence across all ages, but with a notable rise among young adults.

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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.

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