2. Guiding principles
Early diagnosis.
Find out treatable causes
Optimization of physical
health, cognition activity and well
being.
Detection and treatment of BPSD.
Educating care taker and providing
long term support to care taker
3. Diagnosis
Initial evaluation: Further tests as
MRI of brain, possibly also indicated:
CT Lumbar puncture
ESR, CRP Antibodies: ANA, anti-
complete blood count and dsDNA,
smear Intestinal biopsy, brain
Na, K, Ca, glucose biopsy
Serum electrophoresis Urine screening for amino
LFT acids and disorders of
carbohydrate metabolism
HIV, syphilis
serology, Lyme, herpes Genetic analysis
simplex, and other
serological test
Thyroid function test
Vitamin B12, folic acid
4. Imp Drugs
Cholinesterase Inhibitors (ChEIs)
donepezil, rivastigmine and
galantamine.
The NMDA receptor antagonists
(memantine)
Moderate to severe stages of AD and
VaD
Useful to improve cognitive function
and behavioral symptoms
5. MOA, dose
Rivastigmine – Inhibits AChE and
BuChE, that predominates in brain, Dose:
Intially 1.5mg BD, increases every 2
weeks by 1.5mg/day upto 6 mg/BD
Donepezil – cerebroselective & reversible
anti – AChE, Dose: 5mg OD HS
Galantamine – natural alkaloid, anti –
AChE, Dose: 4mg BD
Memantine – NMDA receptor
antagonist, appears to block excitotoxicity
of glutamate, Dose: start with 5mg
OD, increase upto 10mg BD, stop if no
clinical benefit in 6 months
7. Behavioral and Psychological
Symptoms of Dementia (BPSD)
Atypical anti-psychotics
SSRI
Carbamazepine
Simple low-cost strategies to manage
BPSD. Ex: massage, music and
aroma therapy
8. Support for Care takers
Psycho-educational
interventions, many of which include
an element of care taker training.
Psychological therapies e.g. cognitive
behavioral therapy (CBT), and
counseling.
Care taker support and care.
9. Evidence based Rx
Partially effective treatments are
available for most core symptoms of
dementia.
Symptomatic, but do not alter the
progressive course of the disease.
Importantly, psychological and
psychosocial interventions (sometimes
referred to as 'non-pharmacological'
interventions) may be as effective as
drugs, but have been less extensively
researched, and much less effectively
promoted.
10. Modifiable risk factors
Role of cardiovascular risk factors (CVRF)
and cardiovascular disease (CVD) in the
aetiology of dementia and AD.
Smoking increases the risk of AD.
Midlife hypertension and
hypercholesterolemia are associated with
AD onset in later life.
Diabetes
Atherosclerosis and AD are linked disease
processes, with several common underlying
factors (the APOE e4
gene, hypertension, increased fat intake
and obesity, raised