Dementia

Non-Pharmacologic

A. Behavioural strategies such as

• Clear and respectful communication
• Ensure safe environments/places for patient to wander
• Caregiver strategies such as distraction, avoiding confrontation, and providing stimulation and structure

B. Multidisciplinary approach including psychology and recreation therapy

• Involve family and other caregivers
• Establish advance health directives and durable power of attorney before disease hampers competence
• Remove environmental hazards to prevent falls, burns
• Counsel patient against driving after the initial stages of the disease
• Anticipate caregiver stress and provide support

 Pharmacologic

Cholinesterase inhibitors.

• Donepezil initial dose 5mg/day po. Target is 10mg/day.
• SE: lower seizure threshold, GI ulceration, exacerbate asthma and COPD. Headache, nausea, vomiting, anorexia, headache, fatigue, sleep disturbance

N-methy-D-aspartate Receptor antagonists:

• Memantine. 5mg daily po. Increase at 5mg daily at weekly interval to 10mg BID starting at week 4.
• SE: dizziness, headache,confusion, constipation, nausea/vomiting.

Other drugs used in dementia are antipsychotics (olanzapine, quetiapine, risperidone) and serotonergic antidepressants such as Trazadone