mild cognitive impairment without functional impairment
MOCA: <26 or < 25 for less educated
1/2 develop dementia in 5 years
Dementia
population
1/3 people at 90 years old
1/10 people at 80 year old
1/20 people at 70 year old
Normal aging: slowing over time, short term memory should be ok
Dementia = cognitive impairment (moca) and functional impairment (IADL/ADL)
Diagnoses based on functional status and not based on MOCA alone
IADL: driving, meds, finances
ADL: bathing, dressing, eating
Takes 10 years on average to go from early to late dementia
Typical Dementia Sx
delusion, hallucinations
aggressions
paranoid
memory loss
Early dementia:
only IADL impaired
tangential, paucity of thoughts
short term memory loss, execution problems
MOCA < 20 or 15
Moderate dementia:
some ADL impairment
speak 1-2 sentences
Late dementia:
all ADL impairment
problems with ambulation, eating, falling
2-3 words
Death: from pneumonia, fall, hip fx
Dementia Medications
Sinemet
carbidopa-levodopa: carbidopa for CNS. Levodopa for peripheral.
basically dopamine
take on empty stomach only
half life 4 hours
need it during the day
wake up => 10-50
lunch => 10-50
dinner => 10-50
no sinemet at night
Dosing
start 10-25 or 10-50
then 25-100
then 50-100 at lunch or 50-200 at lunch
no BID dosing
Symptomatic
SSRI, first line for all of the dementia sx:
sertraline 25mg week 1, go up to 50 then reassess in 2-3 weeks, go up to 100 or 150
Celexa (least drug drug): 10-40mg, minimum drug drug interaction, no CYP
Lexapro (least cardiac): 5-20mg, no QTC prolongation
Remeron
Antipsychotic: seroquel 25 (really need to 200mg for effect), risperidol 0.5, zyprexa 20. Not using these for psychosis. Take off very slowly, 25% every 2-3 weeks. Always try to go down on antipsychotics