Dementia

Question 1

Most common cause of dementia in the UK

Answer 1

Alzheimer’s disease followed by vascular and lewy body dementia

Question 2

Which assessment tools are recommended for use in dementia

Answer 2

10-point cognitive screener(10-CS)

6-item cognitive impairment(6CIT)

Question 3

Risk factor for alzheimer’s disease

Answer 3

Down’s syndrome

Question 4

Macroscopic pathological changes in alzheimer’s disease

Answer 4

Widespread cerebral atrophy, particularly involving the cortex and hippocampus

Question 5

Microscopic pathological changes in alzheimer’s disease

Answer 5

Cortical plaques due to deposition of type A beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein

Question 6

Biochemical pathological changes in alzheimer’s disease

Answer 6

There is a deficit of acetylcholine from damage to an ascending forebrain projection

Question 7

Non-pharmacological management of alzheimer’s disease

Answer 7

Range of activities to promote wellbeing that are tailored to person’s preference

Group cognitive stimulation therapy for patients with mild and moderate dementia

Group reminiscence therapy and cognitive rehabilitation

Question 8

Pharmacological management of alzheimer’s disease

Answer 8

Acetylcholinesterase inhibitors(donepezil, galatamine and rivastigmine)

Memantine second line

Question 9

In which situations is memantine recommended in management of alzheimer’s disease

Answer 9

Moderate alzheimer’s who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors

As an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe alzheimer’s

Monotherapy in severe alzheimer’s

Question 10

When is donepezil contraindicated

Answer 10

Bradycardia

Adverse effects include insomnia

Question 11

Characteristic pathological feature in lewy body dementia

Answer 11

Alpha-synuclein cytoplasmic inclusions(lewy bodies) in the substantia nigra, paralimbic and neocortical areas

Question 12

Features of lewy body dementia

Answer 12

Progressive cognitive impairment(early impairments in attention and executive function rather than just memory loss)

Cognition may be fluctuating(usually before parkinsonism)

Parkinsonism

Visual hallucinations

Question 13

Diagnosis of lewy body dementia

Answer 13

Usually clinical

Single-photon emission computed tomography(SPECT) is increasingly used(also known as DaTscan)

Question 14

Management of lewy body dementia

Answer 14

Acetylcholinesterase inhibitors and memantine

Question 15

Which medications should be avoided in lewy body dementia

Answer 15

Neuroleptics as patients are extremely sensitive and may develop irreversible parkinsonism

Question 16

What is vascular dementia

Answer 16

Not a single disease but a group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease

Question 17

Main subtypes of vascular dementia

Answer 17

Stroke-related VD - multi-infarct or single-infarct dementia

Subcortical VD - caused by small vessel disease

Mixed dementia - presence of both VD and alzheimer’s disease