Dementia

Question 1

Commonest aetiologies of dementia are:

Answer 1

Alzheimer’s disease, Vascular and Lewy body dementia.

Question 2

Dementia diagnosis

Answer 2

These conditions are difficult to diagnose and there are many assessment tools e.g. GPCOG, abbreviated mental test score (AMTS) and the mini-mental state examination (MMSE)

Question 3

Dementia investigation pathway

Answer 3

– 1st do a cognitive assessment e.g. MOCA

– Exclude reversible causes – do FBC, U&E, LFTs, calcium, glucose, TFT, Vit B12 and folate (2)

– Imaging – CT head (structural causes) and MRI (vasculature changes)

Question 4

What is Alzheimer’s disease?

Answer 4

The number one cause of dementia in the UK is Alzheimer’s disease. The disease is characterised by a progression degeneration of the cortex and typically occurs sporadically and in the elderly.

Question 5

Early onset of Alzheimer’s can be seen in

Answer 5

families (autosomal dominant mutation in presenilin) + Down’s syndrome

Question 6

Alzheimer’s pathogenesis

Answer 6

Pathogenesis of the disease is controversial however it is known that the degradation product of amyloid precursor protein, B-amyloid peptide accumulates, giving rise to amyloid plaques.

In addition, tau proteins are know to coalesce to form neurofibrillary tangles destroying ACh neurones

Question 7

Alzheimer’s Symptoms

Answer 7

– Memory loss (loss of memory is slow and progressive- beginning with short-term memory and later affecting long term episodic memory)

– Learned motor and language skills lost over time

– Changes in behaviour (aggression) and personality

Question 8

Alzheimer’s Diagnosis

Answer 8

This is based on clinical suspicion once other diseases have been ruled out