Dementia

Question 1

Symptoms of dementia?

Answer 1

memory loss
problems with reasoning/communication
Difficulty in making decisions
Dysphasia
Difficulty in coordinating movements e.g. dressing
Disorientation and unawareness of time/place
Difficulty with planning, judgement, loss of initiative and problem solving.

Question 2

Behavioural and psychological symptoms?

Answer 2

psychosis
agitation and emotional liability
depression and anxiety
Disinhibition
Withdrawal or apathy
motor disturbance
sleep cycle disturbance/ insomnia
Tendency to repeat phrases or Qs
Difficulties with activities of daily living

Question 3

Assessment for dementia?

Answer 3

Take history (from patient and also from family/friend)
- informant questionnaire on cognitive decline
Timescale of onset of symptoms & deterioration
acute
Physical examination including neurological signs
- coordination/gait problems
-sensory findings
-motor symptoms
Blood tests- assessing cognitive decline
Assess cognitive decline- 10 point cognitive screener

Question 4

Risk factors for Dementia

Answer 4

Medication history
FH of dementia
Alcohol and drug use

Question 5

Differential diagnosis

Answer 5

Age related decline
Mild cognitive impairment
depression
delirium
vitamin deficiency- thiamine, B12
Hypothyroidism
Adverse effects of medication

Question 6

presenting symptoms specifically for Alzheimers

Answer 6

Loss of recent memory first + often difficulty without executive function &/or nominal dysphasia

Loss of episodic memory
Cognitive deficits - aphasia, apraxia and agnosia

Question 7

presenting symptoms specifically for Vascular dementia

Answer 7

stepwise increase in severity of symptoms- subcortical ischaemic
focal neurological signs

Question 8

presenting symptoms specifically for Dementia with Lewy bodies

Answer 8

-Core clinical feautures are fluctuating cognition- recurrent visual hallucinations
REM sleep behaviour disorder
1 + symptom of Parkinson’s

• memory impairment may not be apparent in early stages

Question 9

presenting symptoms specifically for Frontotemporal dementia

Answer 9

Personality change
behavioural disturbance
cognitive function may be relatively preserved

Question 10

First line treatment of dementia?

Answer 10

Acetylcholinesterase (Ache inhibitors) as mono-therapy mild-moderate Alzheimers

Question 11

If the patient has severe Alzheimers or is intolerant to general first line what medication should be given?

Answer 11

Memantine

Question 12

What should be given for Non- Alzheimers Dementia?

Answer 12

Ache/ Memantine - unlicensed but can be used under specialist care

Question 13

First line treatment for dementia with Lewy bodies and then if 1st line is not tolerated what should be given?

Answer 13

Donepezil or Rivastigamine - 1st line

If Don… or Riv…. not tolerated then Galantamine should be given

Question 14

Vascular Dementia treatment?

Answer 14

AchE inhibitors or memantine

Question 15

What drugs should patients with Frontotemporal dementia not be offered?

Answer 15

AchE inhibitors or memantine

Question 16

Examples of Ache inhibitors

Answer 16

Donepezil, Galantamine and Rivastigamine

Question 17

Which organisation should be notified when a patient has either suspected or confirmed dementia?

Answer 17

DVLA