3+ Dementia

Question 1

What is dementia?

Answer 1

• Organ brain syndrome
• Global impairment of cognition, social and occupational functioning
• Affects ADLs
• Clinical syndrome
• Progressive, leading to dependency and death

Question 2

How does mild cognitive impairment (MCI) differ from dementia?

Answer 2

MCI:
- Evidence of cognitive impairment
- Amnestic or non-amnestic
- DOES NOT affect activities of daily living
- Some will improve

Question 3

What are the most common dementia subtypes?

Answer 3

60% Alzheimer’s
20% Vascular
10% Mixed
4% DLB
2% FTD
2% PDD
2% other

Question 4

If a patient has a rapidly progressive dementia (occurs over months) what should you do?

Answer 4

Refer to a neurological service for LP/EEG to examine for rarer conditions like CJD

Question 5

People <65 have a greater incidence of what type of dementia?

Answer 5

FTD

Less vascular dementia

Question 6

What are the overall requirements for a diagnosis of dementia?

Answer 6

• Clinical evaluation (history, examination, functional assessment)
• Cognitive assessment
• Basic laboratory evaluation
• Structural imaging
• Other Ix if indicated

Question 7

What are the aims of dementia assessment?

Answer 7

1. Establish if they have dementia
2. Exclude other conditions
3. Establish sub-type
4. Evaluate the impact
5. Evaluate family and social support
6. Evaluate comorbidity

Question 8

What are some common symptoms that may be clues someone has dementia?

Answer 8

• Memory loss; losing things, missing appointments
• Confusion
• Repetitiveness
• Becoming lost in a familiar area
• Personality change (irritable, inappropriate, hoarding, indifference, rituals
• Apathy and withdrawal
• Apraxia (forgetting how to use things)
• Agnosing (not recognising objects)
• Impaired language skills
• Loss of ability with iADLs

Question 9

What are some common symptoms that may be clues someone has dementia?

Answer 9

• Memory loss; losing things, missing appointments
• Confusion
• Repetitiveness
• Becoming lost in a familiar area
• Personality change (irritable, inappropriate, hoarding, indifference, rituals
• Apathy and withdrawal
• Apraxia (forgetting how to use things)
• Agnosing (not recognising objects)
• Impaired language skills
• Loss of ability with iADLs

Question 10

What are some potentially reversible causes of cognitive impairment?

Answer 10

Delirium
Depression/anxiety
Alcohol/substance use
Medication: BZD, narcotics, anti-epileptics
Neurological disease
Normal Pressure Hydrocephalus (NPH)
B12/folate deficiency
Hypothyroid
Hypercalcaemia
Neurosyphilis
Cerebral vasculitis

Question 11

What are some aspects of the history from a patient with suspected dementia?

Answer 11

• Symptoms (cognitive, mood, BPSD)
• Collateral
• Time course: onset + progression
• PMHx, Meds, FamHx
• Vascular RFs
• Functional decline: ADLs, iADLS
• RFs: alcohol, head injury, mood disorders
• Driving
• Safety
• Living arrangements
• Legal (will, EPA/EPG, advanced care planning)

Question 12

What are ADLs?

Answer 12

Activities of Daily Living

Bathing
Toilet
Grooming
Dressing
Transferring
Feeding