Dementia Rachel Barr Pharm D Ben Miskle Pharm

Dementia Rachel Barr, Pharm. D Ben Miskle, Pharm. D

Objectives • Review medications for dementia • Review side-effects of medications used for dementia • Identify medications that can worsen memory • Identify ways to help your provider make decisions for your healthcare

Dementia Overview A disorder characterized by a decline in cognition involving learning, memory, language, attention, motor skills, and social skills that are severe enough to interfere with daily function and independence Neurocognitive Disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 5 th ed.

Symptoms of Dementia • Memory loss • Difficulty communicating or finding words • Disorientation • Inability to recognize objects, people, shapes, sounds, etc. • Difficulty with reasoning, problem solving, or complex tasks • Difficulty with motor functions and coordination Neurocognitive Disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 5 th ed.

Symptoms of Dementia • Personality changes • Depression • Anxiety • Inappropriate behavior • Agitation • Hallucinations Neurocognitive Disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 5 th ed.

Causes of Dementia • Dementia can be caused by many different types of diseases • These diseases may lead to damage or loss of nerve cells and their connections in the brain Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Pharmacologic Treatment Options Donepezil Memantine Galantamine Rivastigmine Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Cholinesterase Inhibitors Donepezil Galantamine Rivastigmine Three of our treatment options work to prevent the breakdown of acetylcholine, which is an important neurotransmitter needed for memory and mood. They are therefore called cholinesterase inhibitors. Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Cholinesterase Inhibitors Medication Brand Name Dosage Form Indication Donepezil Aricept Tablet or oral disintegrating tablet Mild to severe disease Rivastigmine Exelon Capsule, oral solution, or transdermal patch Mild to moderate disease Galantamine Razadyne Tablet or oral solution Mild to moderate disease Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Pharmacologic Treatment Options Donepezil Memantine Galantamine Rivastigmine Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Other agents (Memantine) Memantine is another medication used for dementia. It works to reduce the amount of toxic chemicals produced that can harm the brain. Memantine Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Other agents (Memantine) Medication Brand Name Dosage Form Indication Memantine Namenda, Namenda XR Tablet and oral solution Moderate to severe disease Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Side Effects of Medications Medication Side Effect Donepezil, Rivastigmine, Galantamine • Nausea, vomiting, and diarrhea are most common • Dizziness, heart and blood pressure changes • GI bleeds • Abnormal or vivid dreams • Headache • Confusion • Dizziness • Hallucinations • Constipation Memantine Alzheimer Disease. In: Pharmacotherapy: A Pathophysiologic Approach. 10 th ed.

Medications to Avoid Drug Class Examples Anticholinergics Benztropine, Trihexyphenidyl, Biperiden, and Procyclidine Antihistamines Chlorpheniramine, Diphenhydramine, Hydroxyzine, Promethazine Muscle Relaxants Carisoprodol, Cyclobenzaprine Anxiolytics Benzodiazepines such as Xanax, Ativan, Valium, etc. Use of anticholinergic medications by older adults with dementia. J AM Geriatr Soc.

Other Things Affecting Medication Effectiveness • Storage of medications • Missed days between medication doses • Stopping a medication before discussing with provider or pharmacist • Timing of medications • Provider counseling of medications • Using reminders to take medications • Cost Primary medication non-adherence: analysis of 195, 930 electronic prescriptions. J Gen Intern Med.

How Can I Help My Provider Determine What’s Best For Me? ? ? Keep a medication list Take all medications as prescribed Help your provider make the best decision for you Don’t be afraid to ask questions Make sure your pharmacy knows all medications you are taking

References 1. Diagnostic and Statistical Manual of Mental Disorders (5 th Ed). American Psychiatric Association, Arlington, VA. 2013. 2. Di. Piro J, Talbert R, Yee G, et al. Alzheimer’s Disease. In: Pharmacotherapy: A Pathophysiologic Approach 10 th ed. New York, NY. 2017. 3. Roe C, Anderson M, Spivack B. Use of anticholinergic medications by older adults with dementia. J AM Geriatr Soc. 2002; 50: 836 -42. 4. Fischer MA, Stedman MR, Lii J, et al. Primary medication nonadherence: analysis of 195, 930 electronic prescriptions. J Gen Intern Med. 2010; 25: 284 -290.