February 12, 2018
#82 Dementia Dos and Don’ts: The GeriSiders
The Curbsiders Internal Medicine PodcastAbout this episode
Challenge your beliefs on the efficacy of pervasive treatments used in dementia with expert Eric Widera, MD, Professor and clinician-educator in the Division of Geriatrics at the University of California-San Francisco. We explore the use of cholinesterase inhibitors, antipsychotics for behavior disturbances, feeding tubes, medications and supplements used for weight gain (inspired by Choosing Wisely and the American Geriatric Society’s “Ten Things Clinicians and Patients Should Question”). Plus, we introduce our new correspondent, Dr. Leah Witt, Geriatrics Fellow at UCSF. Written and produced by: Jordana Kozupsky, NP, Nora Taranto, MS3, Leah Witt, MD; Edited by: Matthew Watto, MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes , recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Self Assessment Questions Take the quiz now! Time Stamps 00:00 Disclaimer 00:37 Guys set up the show 02:00 Dr Widera’s bio 03:15 Getting to know our guests 13:10 Picks of the week 16:40 Clinical case: new diagnosis of dementia 17:40 Discussing dementia with patients and caregivers 23:42 Cholinesterase inhibitors 27:35 Stopping cholinesterase inhibitors 33:35 Follow up to therapy 36:05 Dealing with behavior disturbances 39:15 DICE approach 44:17 Risks of antipsychotic medications 48:00 Use of benzos or sedative hypnotics 49:45 Melatonin for delirium or sleep 52:00 Mirtazapine 53:54 Clinical case: patient with dementia not eating 54:40 Feeding tubes 59:40 Dysphagia and NPO orders 62:04 Misinformation on malnutrition and girth creep 65:10 Thickened liquid challenge 70:25 Appetite stimulants 72:38 Megestrol 73:54 Take home points from Dr Widera 79:17 Outro Tags: dementia, donepezil, cholinesterase, inhibitor, antipsychotic, behavior, disturbance, agitation, benzodiazepine, supplement, feeding, tube, restraints, thickened, liquids, geriatric, choosing, wisely, american, society, ags, assistant, care, doct