#82 Dementia Dos and Don’ts: The GeriSiders

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 12 February 2018

⏱️ 81 minutes

🔗️ Recording | iTunes | RSS

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Summary

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

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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

Transcript

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0:00.0	uf
0:30.0	Welcome back to the Curve Siders.
0:38.0	Well, I'm Matt. How are you doing?
0:40.0	I'm doing well. I'm doing well with you.
0:42.0	I'm doing well with you.
0:43.0	I'm doing well with you.
0:44.0	I'm doing well with you.
0:45.0	I'm doing well with you.
0:46.0	Paul, are you there too?
0:47.0	It's still working.
0:48.0	We might as well jump right into that.
0:49.0	Yeah, so of course, those are my co-hosts, Dr. Stuart Brigham and Dr. Paul Williams.
0:51.0	And this isn't internal medicine podcast.
0:54.0	That's right. What do we do on this podcast?
0:56.0	I do wonder sometimes.
0:58.0	Paul, what do we do on this podcast?
1:00.0	So we use expert interviews to bring clinical pearls and practice changing knowledge to you,
1:05.0	the listener.
1:06.0	Thank you, Paul.
1:07.0	And on this episode, we have quite a bit of practice changing knowledge.
1:11.0	I have to imagine we're joined by correspondent Dr. Leo Witt.
1:17.0	And our guest is Dr. Eric Widera.
	...

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