Dementia

Question 1

What is dementia?

Answer 1

A group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life.

Alzheimer’s disease is the most common cause of a progressive dementia in older adults

Question 2

What is the prevalence of dementia in people over 65 and 85, respectively?

Answer 2

Over age 65 there is a 6% prevalence and over age 85 the prevalence increases to 20%

Question 3

What are the different types of dementias?

Answer 3

1. Alzheimers
2. Vascular dementia
3. Lewy body dementia
4. Frontotemporal dementia.
5. Mixed dementia

Question 4

What causes Alzheimer’s disease?

Answer 4

While several genes are probably involved in Alzheimer’s disease, one important gene that increases risk is apolipoprotein E4 (APOE).

Alzheimer’s disease patients have plaques (beta-amyloid between cells) and tangles (tau in cells) in their brains. It’s thought that these clumps damage healthy neurons and the fibers connecting them.

Question 5

What are the main signs of Alzheimer’s disease?

Answer 5

1. Language - difficulty finding words
2. Apraxia - impaired ability to carry out skilled motor activities
3. Agnosia - failure to recognise objects

Question 6

What are the main signs of vascular dementia?

Answer 6

Difficulties with problem-solving, slowed thinking, and loss of focus and organisation

More noticeable than memory loss

Question 7

What are the main signs of Lewy-body dementia?

Answer 7

Acting out one’s dreams in sleep, visual hallucinations, and problems with focus and attention. Uncoordinated or slow movement, tremors, and rigidity

Can lead to falls

Question 8

What causes Lewy body dementia?

Answer 8

Lewy bodies are abnormal balloonlike clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer’s disease and Parkinson’s disease.

This is one of the more common types of progressive dementia.

Question 9

What causes frontotemperal dementia?

Answer 9

Breakdown of nerve cells and their connections in the frontal and temporal lobes of the brain

Question 10

What are the main signs of frontotemporal dementia?

Answer 10

These are the areas generally associated with personality, behaviour and language.

Common symptoms affect behaviour, personality, thinking, judgment, and language and movement.

Question 11

As a clinical syndrome, what is dementia defined by?

Answer 11

1. An acquired loss of higher mental function, affecting two or more cognitive domains including:
   a. Episodic memory
   b. Language function
   c. Frontal executive function
   d. Visuospatial function
   e. Apraxia or agnosia
2. Of sufficient severity to significantly cause social or occupational impairment
3. Occurring in clear consciousness (to distinguish it from delirium).

Question 12

What cognitive changes are associated with dementia?

Answer 12

• Memory loss, which is usually noticed by someone else
• Difficulty communicating or finding words
• Difficulty with visual and spatial abilities, such as getting lost while driving
• Difficulty reasoning or problem-solving
• Difficulty handling complex tasks
• Difficulty with planning and organizing
• Difficulty with coordination and motor functions
• Confusion and disorientation

Question 13

What psychological changes are associated with dementia?

Answer 13

• Personality changes
• Depression
• Anxiety
• Inappropriate behavior
• Paranoia
• Agitation
• Hallucinations

Question 14

How would you diagnose dementia?

Answer 14

History

1. Taking a history from a spouse or relative is essential.
2. Patients may tend to downplay or deny symptoms (anosognosia) or constantly look to the relative for answers (the ‘head-turning sign’)

The mini-mental state examination (MMSE)

Question 15

What does history taking for a dementia diagnosis include?

Answer 15

Memory
Functional ability
Personality and frontal lobe functioning
Language
Visuospatial ability
Psychiatric features

Ask about family history and drug use!

Question 16

How do you manage dementia?

Answer 16

Management is supportive, to preserve dignity and to provide care for as long as possible in the familiar home environment.

The burden of illness falls frequently on relatives and they need to be supported

Depression is common in dementia and may be difficult to distinguish from dementia symptoms such as apathy and worsening cognitive function. A trial of an antidepressant is appropriate where depression is suspected

Driving safety assessment.

Question 17

What is the prognosis for dementia?

Answer 17

Dementia robs patients of their independence, is a serious burden on carers and a major socioeconomic challenge for society as a whole.

Question 18

What medications can be given to a dementia patient?

Answer 18

1. Cognitive enhancers (They have a modest symptomatic benefit in AD)
2. Cholinesterase inhibitors (increase brain acetylcholine levels by inhibiting CNS acetylcholinesterase)

Question 19

A 70 year old man sees his GP, accompanied by his daughter. She is worried that her father has been struggling with his day to day activities. He seems to be seeing things and people which she cannot see. She has noticed that his walking has become slow and stiff. He had a fall the day before, which is why she has brought him to the surgery.

Which is the most likely diagnosis?

Answer 19

Lewy body dementia. If it sounds like parkinsons and have dementia symptoms then its Lewy body dementia – visual hallucinations, Parkinsonism and falls.