Dementia in Alzheimer’s disease

Donepezil 10 mg /day, start with 5mg/day, increase 5mg daily after 4 weeks

Rivastigmine 6 mg bd, start with 1.5 mg bd increase every 2 weeks by 1.5 mg bd

Galantamine 12 mg bd, start with 4mg bd increase at 4 weekly intervals by 4mg bd          

Memantine 10 mg bd, start with 5mg/day increase by 5mg/day at weekly interval              

Nonpharmacological therapies

Sensory stimulation

Behavior management

Social contact

Exercise

Structured activities programs

Environmental modifications

Carer education and support

Combination therapies

Comorbidities in dementia

Diarrhea

Recommended drugs: Loperamide is not known to have effects on cognition but is low potency anticholinergic

Hyperlipidemia

All statins safe but atorvastatin and pravastatin safest

Constipation

Recommended drugs. No evidence of laxatives on cognitions. Constipation may worsen cognition,

Hypersalivation

Pirenzepine, Atropine sublingual

Asthma/COPD

Recommended drugs, Beta-agonists ((remember tremors as a side effect), Inhaled anticholinergics have not been reported to affect cognition, Theophylline

Hypertension

CCBs, ARBs, ACE Inhibitors

Allergy

Recommended drugs, Cetirizine, loratadine, Fexofenadine

Infections

Use the most appropriate antibiotics

Nausea/vomiting

Recommended drugs: Domperidone (caution movement disorders) 5-HT3 receptor antagonists eg ondansetron, granisetron

Spasmodic GI pain

Mebeverine, Alverine, Buscopan, Peppermint oil

Pain

Recommended drugs Paracetamol oxycodone buprenorphine Topical NSAIDs where appropriate

Urinary frequency

Darifenacin, Trospium

Urinary retention

Recommended drugs Alpha-blockers are not known to have effects on c