Dementia

Question 1

Screening tools?

Answer 1

MMSE of <24/ 30 suggests dementia.

Question 2

Management

Answer 2

Blood screen to rule out reversible cause, neuroimaging
Cognitive stimulatory activities
Pharmacological management

Question 3

Common and rare causes

Reversible causes

Answer 3

Alzheimer’s disease
Cerebrovascular disease
Lewy body dementia

Huntington’s
Pick’s disease
HIV AIDS

Hypothyroidism, B12/folate deficiency, syphilis, brain tumour, subdural haematoma, depression

Question 4

Alzheimer’s disease- microscopic changes

Answer 4

A-beta-amyloid protein deposition, aggregation of tau protein.
Widespread cerebral atrophy especially in cortex and hippocampus.

Question 5

Alzheimer’s disease- management

Answer 5

3 acetylcholinesterase inhibitors e.g. donepezil, galantamine and rivastigmine

2nd line: memantine

Antipsychotics if hallucinations or delusions causing severe stress.

Question 6

Vascular dementia risk factors and features

Answer 6

History of stroke/TIA
AF
HTN
DM
Hyperlipidaemia
Smoking
Obesity

Several months of stepwise deterioration of cognitive function.
Visual/sensory/motor abnormalities, difficulty concentrating, seizures, memory disturbance, speech disturbance, emotional disturbance.

Question 7

Vascular dementia management

Answer 7

Cognitive stimulation programmes.

Only AChE inhibitors or memantine if comorbid Alzheimer’s, Parkinson’s or Lewy body.

Question 8

Lewy body dementia- cause and symptoms

Answer 8

Lewy bodies in substantia nigra, paralimbic and neocortical areas.

Progressive cognitive impairment especially in attention and executive function. Cognition may be fluctuating.
Parkinsonism and visual hallucinations.

Question 9

Lewy body dementia management

Answer 9

AChE inhibitors - donepezil, rivastigmine

Memantine

Question 10

What suggests depression over dementia?

Answer 10

Short history and rapid onset, weight loss, sleep disturbance, patient aware, reluctant for tests, global memory loss.