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Mmse targetedsymptomstoresolveortoemerge tnd 2005

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Unformatted text preview: impression of change based on interview with patient and caregiver. MMSE Targeted symptoms to resolve or to emerge. © TND 2005 ISSUES IN CLINICAL PRACTICE: WHEN IS IT TIME TO STOP A CI? Intolerable side­effects (ex. insomnia, nausea/vomiting/diarrhea, muscle cramps). Clear deterioration of symptoms over the first 6 months. Loss of response over time. ­> consider switching to another CI. © TND 2005 SWITCHING BETWEEN CI (Morris et al, Clin Ther 23; Suppl A, A31-A39, 2001) (Morris No wash out required unless unresolved side ­effects from first CI Monthly titration of second CI Monitor for efficacy and tolerability monthly for 3 months Combinations of CI are not recommended © TND 2005 DIAGNOSTIC CRITERIA FOR DIAGNOSTIC VASCULAR DEMENTIA VASCULAR Decline in intellectual function interfering with daily life not due to physical effects of stroke(s) alone. Evidence by Hx, physical and/or brain imaging of stroke(s). Temporal relationship between dementia and cerebrovascular disease. © TND 2005 LS mean change from baseline ADAS-cog score Donepezil in VaD: LS Mean Change in Donepezil ADAS-cog ADAS-cog – 4 – 3 *** – 2 – 1 0 *** Donepezil 10 mg *** ** *** ** Clinical improvement Baseline 1 2 *** ***...
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