11. Dementia And Epilepsy

Question 1

What is the definition of dementia?

Answer 1

Progressive decline in higher cortical function leading to a global impairment of memory, intellect and personality which effects the individuals ability to cope with activities of daily living.

Question 2

Name 3 reversible conditions that can lead to dementia-like symptoms.

Answer 2

Depression, trauma, vitamin deficiency, alcohol, thyroid disorders.

Question 3

How does dementia present?

Answer 3

Memory deficit, behavioural changes, physical changes eg incontinence, language disorder, visuospatial disorder and apraxia.

Question 4

What investigations would you carry out if you suspected a patient had dementia?

Answer 4

Full history (collateral from family) and MMSE.
Full neurological examination.
Blood tests for reversible causes eg TFTs and Vit B12.
CT/MRI head.
Memory clinic follow up.

Question 5

What can be used to distinguish delirium from dementia?

Answer 5

CAM (confusion assessment method) score.
If two or more of the following then is likely to be delirium:
Acute change or fluctuating mental status.
Altered consciousness - hypo/hyperactive.
Inattention.
Disorganised thinking.

Question 6

What is seen pathologically in Lewy Body dementia?

Answer 6

Lewy Bodies in the cortex and substantia nigra.

Question 7

What is seen clinically in a patient with Lewy Body dementia?

Answer 7

Substantial fluctuations in the degree of cognitive impairment over time.
Parkinson’s symptoms.
Visual hallucinations.
Frequent falls.

Question 8

What is seen pathologically in vascular dementia?

Answer 8

Arteriosclerosis of the blood vessels supplying the brain.

Diffuse small vessel disease or infarcts, leading to ischaemia.

Question 9

What is seen clinically in vascular dementia?

Answer 9

Abrupt, step-wise decline in cognitive function related to vascular episode.

Question 10

How is vascular dementia managed?

Answer 10

Assess CVS risk and treat hypertension/high cholesterol.

Question 11

What is seen pathologically in frontotemporal dementias?

Answer 11

Frontotemporal lobar degeneration with tau pathology.
Picks disease - TAU proteins form Pick Bodies in the frontal and temporal lobes.
Familial tauopathies.

Question 12

What is seen clinically in frontotemporal dementias?

Answer 12

Alteration of social behaviour and personality eg agitation and depression.
Impaired judgement and insight eg gambling, taking off clothes, inappropriate comments.
Speech output falls eventually to a state of mutism.

Question 13

What can be done to help manage dementia?

Answer 13

Therapies - eg pets and babies.
Social care - eg risk assessment, care needs, mental capacity act.
Memory aids - eg orientation boards, remembrance therapy, life stories.
Drugs - eg cholinesterase inhibitors, memantine.

Question 14

What is a seizure?

Answer 14

A sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions.

Question 15

What is a convulsion?

Answer 15

Uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles.

Question 16

What is an aura?

Answer 16

A perceptual disturbance experienced by some prior to a seizure, eg strange light, unpleasant smell or confusing thoughts.

Question 17

What is epilepsy?

Answer 17

A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness or convulsions, associated with abnormal electrical activity in the brain.

Question 18

What is status epilepticus?

Answer 18

Epileptic seizures occurring continuously without recovery of consciousness in between. This is a medical emergency as can become cyanotic.

Question 19

What is the difference between partial and generalised seizures?

Answer 19

Partial - just one area of the brain affected. Affects one cerebral hemisphere.
Generalised - one main focal point int he brain, but with lots of other little areas affected. Affects both cerebral hemispheres.

Question 20

What is the difference between simple and complex partial seizures?

Answer 20

Simple - person remains conscious.

Complex - consciousness is impaired.

Question 21

Temporal lobe epilepsy is the most common cause of partial seizures. When does it tend to occur?

Answer 21

In the first or second decade in most people, following seizure with fever or early injury to the brain. Usually preempted by an aura.

Question 22

What is a tonic-clonic generalised seizure?

Answer 22

A seizure causing muscle tensing and convulsions.

Question 23

What is an absence generalised seizure?

Answer 23

Random ‘daydreaming’ eg pause mid conversation, then continue as normal.

Question 24

What is a myoclonic generalised seizure?

Answer 24

A seizure causing brief shock-like muscle jerks.

Question 25

What is an atonic generalised seizure?

Answer 25

A seizure where there is a lack of muscle tone - drop attack.

Question 26

What is a tonic generalised seizure?

Answer 26

A seizure with increased muscle tone.

Question 27

How would you investigate a patient for suspected epilepsy?

Answer 27

Taking a thorough clinical history including what happened before, during and after the seizure, including collateral history.
EEG - is not diagnostic but supports diagnosis.
MRI - to exclude other suspected causes of seizures eg intracerebral mass.

Question 28

What drugs can be used for the initial management of seizures?

Answer 28

Benzodiazepines - lorazepam or midazolam.

Question 29

What are the laws surrounding epilepsy and driving?

Answer 29

When first diagnosed - if suffer from seizures when awake, then licence taken away until 1 year seizure free.
If a medication change causes a seizure - 6 months seizure free.
If seizures are whilst asleep or don’t affect driving or consciousness - assessment of case by DVLA.
If a one-off seizure - wait 6 months seizure free, then assessment by the DVLA.