Dementia

Question 1

Define Dementia

Answer 1

Neurodegenerative syndrome with progressive decline in several cognitive domains i.e. memory loss

Question 2

What are the general causative factors of dementia

Answer 2

Alcohol/drug abuse
Repeated head trauma
Pellagra
Whipple's disease
Huntington's
Parkinson's 
HIV
CADASIL

Question 3

What are the causes of the following: 
Alzheimer's
Vascular
Frontotemporal
Lewy body

Answer 3

Alzheimer’s: senile amyloid plaque and neurofibrillary tangle formation

Vascular: infarction, leukoaraiosis, haemorrhage

Frontotemporal: focal degeneration of the frontotemporal lobes

Lew body: toxic protein aggregation, abnormal phosphorylation, nitration, inflammation

Question 4

Epidemiology of dementia

Answer 4

Alzheimer’s (70-80%) and vascular dementia (17%) are the most common forms of dementia
Around 50 million people have dementia, with nearly 60% in low and middle income countries

Question 5

Symptoms of Alzheimer’s dementia

Answer 5

Gradual and progressive loss in cognitive function

• Amnesia
• Aphasia
• Agnosia
• Apraxia

Memory loss and disorientation
Nominal dysphasia
Misplacing items or getting lost
Apathy 
Decline in ADLs
Personality or mood changes
prosopagnosia

Question 6

Signs of Alzheimer’s

Answer 6

MMSE <27
Gait and neuro exams are normal early in disease
Check for pressure sores and pain

Question 7

Features of vascular dementia

Answer 7

Cumulative effect of many small strokes
Sudden onset and stepwise deterioration is characteristic

Arteriopathy (HTN, past strokes, focal CNS signs)
Location-specific deficits
Motor signs, cognitive deficits, behaviour changes

Question 8

Features of Lewy Body dementia

Answer 8

Visual hallucinations
Fluctuating GCS
Parkinsonism

Question 9

Features of fronto-temporal dementia

Answer 9

Executive impairment
Behavioural/personality change
Disinhibition
Hyperorality, especially with chocolate 
Stereotyped behaviour 
Emotional unconcern
Episodic memory and spacial orientation preserved until later stages

Question 10

Investigations for dementia

Answer 10

Diagnosis is made through history
Investigations to find a potentially reversible cause

TFTs, Vit B12 and folate, thiamine, calcium, MSU, FBC, ESR, U+Es, LFTs, glucose, HIV serology
CT/MRI, EEG

CT: Multiple white hypodensities in vascular dementia