Home CPD Mild cognitive impairment, dementia and Alzheimer’s disease – the basics

Mild cognitive impairment, dementia and Alzheimer’s disease – the basics

CPD

August 5, 2019

CPD credits

Accreditation Number : CAP1908SYPYM

Group 1 : 0.75 CPD credits

Group 2 : 1.5 CPD credits

This activity has been accredited for 0.75 hours of Group 1 CPD (or 0.75 CPD credits) suitable for inclusion in an individual pharmacist's CPD plan, which can be converted to 0.75 hours of Group 1 CPD (or 1.50 CPD credits) upon successful completion of relevant assessment activities.

Introduction

Dementia is a broad term used to encompass a large group of illnesses defined by a progressive decline in a person’s functioning (e.g. memory, intellect, rationality, social skills and physicality). It is most frequently due to, but is not limited to, Alzheimer’s disease (AD). Mild cognitive impairment (MCI) is a preceding state that is also most commonly due to AD and is sometimes called prodromal AD.

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

Define mild cognitive impairment, dementia and Alzheimer’s disease
Describe the signs, symptoms and diagnosis of mild cognitive impairment, dementia and Alzheimer’s disease
Summarise pharmacological and non-pharmacological interventions and any evidence for its use in mild cognitive impairment, dementia and Alzheimer’s disease.

Competencies (2016): 1.1, 1.2, 1.4, 1.5, 3.3, 3.5

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SYMPTOM	CAUSE	VALVE LESION
Fatigue Dizziness, blackouts	Inadequate cardiac output	Stenosis
Shortness of breath, cough Swelling of ankles and feet Abdominal swelling	Congestion	Regurgitation Heart failure
Chest pain	Increased workload	Aortic stenosis
Palpitations	Enlargement of heart chambers	Regurgitation (esp. mitral) Mitral stenosis
Stroke	Blood clots	Mitral

Pharmaceutical classes involved in calls to PICs (% of total exposures)	Most common substance(s) in this class (% of exposures within each class)
Paracetamol-containing analgesics (10.2)	Paracetamol (80.4)
Antidepressants (4.2)	Sertraline (15.0)
NSAIDs (3.9)	Ibuprofen (72.7)
Cardiovascular agents (3.4)	Beta-blockers (22.1), including metoprolol (7.4)
Sedatives (2.9)	Benzodiazepines (83.2), including diazepam (45.5)
Antipsychotics (.27)	Quetiapine (54.2)

Age groups (years)	Circumstance of exposure
Children (0–14)	Mostly unintentional
Adolescents (15–19)	Mostly deliberate self-poisoning
Adults (20–74)	Medication errors, unintentional and deliberate self-poisoning
Older adults (>74)	Medication errors

Reason for exposure	Pharmaceutical	Number of deaths
Unintentional poisoning	*Narcotics and hallucinogens*
	Heroin*	399
	Methadone	212
	Other opioids	402
	*Other pharmaceuticals*
	Benzodiazepines	581
	Antidepressants	337
Intentional poisoning	*Drugs, medicaments or biological substances*
	Benzodiazepines	196
	Antidepressants	182
	Non-opioid analgesics (e.g. paracetamol, NSAIDs)	92

MEDICINE	DOSE	COMMENT
First line Miconazole 2% oral gel	Adults and children ≥2 years: 2.5 mL is topically applied, then swallowed, 4 times a day, after food, for 7–14 days Neonates and children <2 years: 1.25 mL is topically applied, then swallowed, 4 times a day, after feeding, for 7–14 days. Apply at the front of the mouth in small amounts to avoid choking Treatment should continue for 7 days after resolution of symptoms	Patients should be advised to place gel on the tongue and hold in the mouth for as long as possible before swallowing As the primary reservoir for oral Candida carriage, the tongue dorsum is often the initiating point of infection⁹
Second-line Amphotericin B lozenges	Adults and children ≥2 years: 10 mg lozenge is sucked, then swallowed, after food, for 7–14 days. Treatment should continue for 2–3 days after resolution of symptoms	Use with caution in patients with salivary gland hypofunction, as it is difficult to dissolve and the sucking action may further irritate the oral mucosa
Third-line Nystatin oral liquid 100,000 units/mL	Adults and children ≥2 years: 1 mL is topically applied, then swallowed, 4 times a day, after food, for 7–14 days. Treatment should continue for 2–3 days after resolution of symptoms Neonates and children <2 years: 1 mL is topically applied, then swallowed, 4 times a day, after feeding, for 7–14 days. Treatment should continue for 2–3 days after resolution of symptoms	Nystatin liquid contains sucrose. There may be a risk of dental caries The patient must not eat or drink directly after application as successful treatment requires an adequate contact time between the drug and oral mucosa

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Introduction

Learning objectives

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Pharmaceutical poisoning in Australia

Knowledge to practice

Conclusion

Key points:

Case scenario

Learning objectives

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Introduction

What are the causes?

What are the risk factors?

What are the symptoms?

How is it diagnosed?

When to refer

How is it managed?

What is the prognosis?

How can it be prevented?

Knowledge to practice

Conclusion

Case scenario continued

Key points:

Further information

Case scenario

Learning objectives

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Introduction

Epidemiology and risk factors for alcohol dependence

Diagnosis and assessment

Management

Knowledge to practice

Conclusion

Case scenario continued

Key points:

Introduction

Learning objectives

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Preparation

Counselling for patients

Conclusion

Key points:

Introduction

Learning objectives

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Causes and risk factors

Clinical presentation

Diagnosis

Management