7. Aging
Beautifully:Visions & Realities
Part III: Dementia
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By Christine Hortillosa
Pharm.D. 2013 Candidate
University of Texas at Austin College of Pharmacy
5. 9. 2013
8. Delirium
Dementia
Acute
Two of the following:
•Misinterpretation, illusions, hallucinations
•Incoherent speech
•Disturbance in sleep-wake cycle
•Change in psychomotor activity
Related to medical illness + medications
Reversible
Progressive
Marked by memory impairment
Not a normal part of aging
Irreversible
10. mild
moderate
severe
20-
24
Short-term memory loss;
word-finding problems
Loss of IADLs
10-19
Disorientation to time, place,
inability to engage in activities
Needs assistance with ADLs
<10
Loss of speech and
ambulation, incontinence of bowel
and bladder
Dependency in basic ADLs; often requires
around-the-clock care
*ADLS= activities of daily living (bathing, dressing); IADLS=
instrumental activities of daily living (housekeeping); MMSE=
Mini-Mental Status Examination
MMSE Examples of cognitive loss
Examples of functional loss
Stages
12. Donepezil
Starting Dose 5 mg/day; No dose change for renal
impairment
Maintenance Dose 10mg/day
May also increase to 23mg/day
Properties Cholinesterase inh; partly metabolized
by CYP 2D6 and 3A4
Indication For all stages of Alzheimer’s
Adverse Effects Bradycardia, syncope, weight loss,
N/V/D, Insomnia
DDI Anticholinergics, Antipsychotics, Beta-
blockers, Alcohol
Administration At bedtime without regard to food
13. Starting Dose 1.5mg BID; No dosage change for
renal impairment
Maintenance Dose 3-6mg BID
Properties Cholinesterase inh
Indication For mild to moderate Alzheimer’s and
mild-to moderate dementia with
Parkinson’s
Adverse Effects Has most intense cholinergic (N/V/D)
ADE, bradycardia, syncope, dizziness,
EPS
DDI Anticholinergics, Antipsychotics, Beta-
blockers, Alcohol
Administration With meals; for patch (avoid application
to same spot for 14 days)
Rivastigmine
14. Starting Dose 4 mg BID; Use not reco’d for CrCl
<9ml/min
Maintenance Dose 8-12mg BID or 8-24mg ER Qday
Properties Cholinesterase inh and nicotine
receptor modulator; partly metabolized
by CYP 2D6 and 3A4
Indication For mild-to-moderate Alzheimer’s
Adverse Effects Bradycardia, syncope, weight loss,
N/V/D
DDI Anticholinergics, Antipsychotics, Beta-
blockers, Alcohol
Administration With meals; if therapy is interrupted for
3+ days, restart at lower dose and
increase to current dose
Galantamine
15. Memantine
Starting Dose 5 mg/day (max dose of 20mg for CrCl
30-49 and max dose 5mg for CrCl 5-
29)
Maintenance Dose 10mg BID
Properties Blocks glutamate transmission
Indication For moderate to severe Alzheimers;
may be used in combination with
donepezil
Adverse Effects Hypertension, confusion
DDI Sodium bicarbonate, Trimethoprim
Administration Without regard to food
17. How long should
the therapy be?
• Evaluation at 3-6 months for prevention of
decline or improvement
• Conflicting evidence in unresponsive patients
• Taper upon discontinuation
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Today I will discuss Urinary Incontinence, the 2nd part of the Aging beautifully series.
Reversible cause of mental status change: alcohol abuse, thyroid dysfunction, dehydration and electrolyte disturbance, infection, vit b12 deficiency, medications: anticholinergics (for overactive bladder, tiotropium for asthma
IADLS (laundry, housekeeping, managing meds, may get lost in familiar places)
AP can enhancetherapietic
AP can enhancetherapietic
AP can enhancetherapietic
AP can enhancetherapietic
Pharmacists, we have a role to play… As patient advocates and front-line health care professionals we can educate, recommend better treatment alternatives, ensure their safety, and listen… so someday, our patients can say…
