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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Feb 12, 2018

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

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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

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