Dementia

Question 1

What is dementia?

Answer 1

A neurodegenerative syndrome which involves impairment of multiple higher cortical functions, such as memory, thinking, orientation, comprehension and language

Question 2

1) What is the commonest cause of dementia?
2) Name 3 other causes of dementia
3) Name 2 aspects of the diagnosis of dementia

Answer 2

1) Alzheimer’s disease
2) Vascular dementia, dementia with Lewy bodies, frontotemporal dementia, Creutzfeldt-Jakob disease (CJD), Huntington’s disease
3) History and examination, cognitive testing, clinical picture, neuroimaging

Question 3

Vascular dementia
1) What causes vascular dementia?
2) Why does vascular dementia often have a stepwise progression?
3) How do patients with vascular dementia often present?

Answer 3

1) Impaired blood flow to areas of the brain due to vascular damage from ischaemia secondary to cardiovascular disease
2) Progressive infarcts over time
3) Stepwise deterioration of cognitive function.

Question 4

Lewy body dementia
1) What is the characteristic pathological findings in Lewy body dementia?
2) What 2 conditions is dementia with Lewy bodies associated with?
3) What are the 3 main features of Lewy body dementia?
4) What drugs should be avoided and what drugs can be used in Lewy body dementia?

Answer 4

1) Alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the brainstem and neocortex
2) Parkinson’s disease and Alzheimer’s disease
3) Fluctuating cognition, parkinsonism and visual hallucinations
4) Used = acetylcholinesterase inhibitors and memantine. Avoided = antipsychotics

Question 5

Frontotemporal dementia (Pick’s disease)
1) Name 2 characteristic symptoms of frontotemporal dementia
2) Name a difference in the way that frontotemporal dementia presents compared to other forms of dementia?

Answer 5

1) Personality and behavioural changes, language problems, memory impairment
2) Memory impairment presents later in disease progression, presents at a younger age