dementia

Question 1

What is dementia

Answer 1

Dementia describes a clinical syndrome that is characterised by a significant deterioration in mental function that leads to impairment of normal function, where normal function is measured by ADL.

Question 2

What are the different types of dementia?

Answer 2

(1. ) Alzheimer’s disease 50-75% - memory loss, difficulty with functioning
(2. ) Vascular dementia 20% - stepwise increase in severity, gait, attention problems, change in personality. hemiparesis, visual defects may be present.
(3. ) Dementia with Lewy-body 15-20% - recurrent hallucinations, parkinsonism, bradykinesia, tremor, rigidity.
(4. ) Frontotemporal dementia 2% - personality and behaviourally changes

Question 3

What differential must you exclude when considering dementia

Answer 3

The main differentials to exclude in a patient with features of dementia are the three ‘D’s’:

(1. ) Depression. Features distinguishing depression form dementia:
- Depression = Rapid onset and decline (trigger/life event) whereas dementia = vague, insidious onset
- Depression = Subjective complaints of memory loss, dementia = unaware or attempt to hide problems
- Depression = Pt is distressed/unhappy, ‘don’t know answers’, dementia = attempts all Qs

(2. ) Drugs: consider drugs with anti-cholinergic effects (e.g. anti-histamines, anti-psychotics, anti-epileptics)
(3. ) Delirium: acute confusion state. May be prolonged recovery following episode

Question 4

What is Alzheimer’s Disease + RF?

Answer 4

Neurodegenerative disorder causes deterioration in mental performance, impairment in social and occupational function including memory loss, problem-solving or language

Aetiology: amyloid plaques and neurofibrillary tangles deposits causing neuronal death that lead to memory failure. Braak staging stages AD based on these pathological change

• Most cases are sporadic, and both environmental + genetic factors have a role.
• RF: ~60y, APP, PSEN1, PSEN2 mutations, CVD, Depression, Low education attainment, Low social engagement and support, smoking, DM, lack of physical activity, obesity

Question 5

Alzheimer’s Disease clinical features

Answer 5

Can be difficult to identify due to the insidious and non-specific symptoms.

(1.) Cognitive impairment

(2. ) ADL difficulties
- Early stages: problems with higher level function (e.g. managing finances, difficulties at work)
- Later stages: problems with basic personal care + motor function

(3. ) Behavioural and psychological syx
- psychosis, agitation, depression, disinhibition

Question 6

Alzheimer’s Disease Ex + Ix

Answer 6

(1. ) collateral hx from family
(2. ) neuro ex
(3. ) assess cognition e.g. 10-CS, 6-CIT, 6-item screener, MIS, mini-cog, TYM. (Other tools not recommened by NICE - AMTs, MMSE)

(4. ) Exclude other conditions
- Bloods: FBC, CRP/ESR, UE, HbA1c, LFT, TFT, B12 + folate
- Urine dip

(5.) CT/MRI done by specialists

Question 7

Alzheimer’s Disease Mx?

Answer 7

(1. ) Refer to memory clinic
(2. ) Inform DVLA
(3. ) Cognitive stimulation therapy or group or occupation therapy
(4. ) Pharmacological
- AChE inhibitors: donepezil /rivastigmine (1st line)
- NMDA antagonist: memantine
(5. ) End of life care: assess capacity, advanced care planning

Pts with MCI: prevention

(1. ) healthy lifestyle, diet, exercise, reduce alcohol, smoking cessation
(2. ) socially + cognitively active