- Mini – Mental Status Exam – MMSE
- Montreal Cognitive Assessment – MOCA
- St Louis University Mental Scale – SLUMS
Mood screening: Geriatric Depression.Scale
IADL: Instrumental Activities Of Daily Living
- Rule out delirium and drug-related causes.
- Other causes: vitamin B12 deficiency, hypothyroidism, depression, NPH, opioids, sedative-hypnotics, antidepressants, anticholinergics, antiparkinson’s drugs
Initiate a cholinesterase inhibitor in patients with mild to moderate Alzheimer’s disease.
- Donepezil 5-10 mg daily
- Rivastigimine 1.5-6 mg BID or patch
- Galantamine 4-12 mg BID (renal adjustment)
- Memantine 5-10 mg BID (not a CI, NMDA Antagonist, but can be used alone or added to a CI in moderate and severe disease)
- Herbal medicines are not effective, but diet and exercise may help.
- CIs cause nause, vomitting, headache, insomnia, dizziness, bradycardia, orthostatic hypertension, syncope, incontinence, anorexia, falls
- Memantine causes agitation, urinary incontinence, insomnia, diarrhea,
dizziness, confusion, headache.
- Can add SSRI/ SNRI or atypical antipsychotic for symptoms.