Dementia

Question 1

What is the most common cause of Dementia?

Answer 1

Alzheimer’s Disease

Question 2

What is dementia characterised by?

Answer 2

Progressive cognitive, social and functional impairment

Question 3

What has modest symptomatic benefit in early stages of dementia ?

Answer 3

Acetylcholinesterase inhibitors

Question 4

What course does dementia follow?

Answer 4

Heterogenous course

Question 5

Where is the clinical diagnosis most likely to be made?

Answer 5

During the history taking

Question 6

Checklist to interview patients

Answer 6

Memory
Language
Numerical skills
Executive skills
Visuospatial skills
Neglect phenomena
Visual perception
Route finding and landmark identification
Personality
Mood
Anxiety
Delusions
Activities of daily living
+Chronology of each

Question 7

What is dementia?

Answer 7

Severe loss of memory and other cognitive abilities which leads to impaired function (regardless of the underlying cause)

Question 8

What investigations are carried out?

Answer 8

Neuropsychology
Bloods
MRI
PET

Question 9

What is the test for demenita?

Answer 9

MMSE

ACE III
15 minutes, and more memory focused

Question 10

What is checked when taking bloods for dementia?

Answer 10

Full blood count
Inflammatory markers
Thyroid function
Biochemistry and renal function
Glucose
B12 and folate
Clotting

Syphilis serology
HIV
Caueruloplasmin

Question 11

What is the examination for dementia

Answer 11

Neurological - cranial nerves, upper and lower limb gaits

Mental health

Question 12

What levels do you check in pet scans

Answer 12

B amyloid burden

Can also see tau

Question 13

What are the possible differentials for diagnosis

Answer 13

Alzheimer’s
Vascular
Lewy Body
FTD
Depression
Delirium
None

Question 14

What is the management of dementia

Answer 14

Acetylcholinesterase inhibitors
Watch and wait
Treating behavioural/psychological
symptoms
OT/Social services
Specialist therapies

Question 15

How to rule in and rule out other conditions

Answer 15

Delirium vs dementia vs depression
* Dementias and atypical variants

Alzheimer’s
(subtle, insidious amnestic/non amnestic presentations)

Vascular dementia
(related to cerebrovascular diseases with a classical step-wise deterioration +- multiple infarcts)

Dementia with Lewy bodies
(cognitive impairment before/within 1 year of Parkinsonian symptoms, visual hallucinations and
fluctuating cognition)

Frontotemporal dementia
(behaviour variant FTD, semantic dementia, progressive non-fluent aphasia)

Rapidly progressing dementias

Question 16

What are the biomarker patterns in Alzhemiers

Answer 16

AB Amyloid
Tau mediated neuronal
Injury and dysfunction
Brain structure
Cognition

Question 17

In what structures are there dysfunctions in Alzheimers

Answer 17

Medial temporal lobe structures (entorhinal cortex and hippocampus)

Question 18

What does dementia with Lewy Bodies show

Answer 18

Associated with fluctuating cognition
* Different cognitive profile to Alzheimer’s Disease
* Often visual hallucinations
* REM sleep disorder
* Development of symptoms associated with Parkinson’s
Disease
* High risk of falls

Increase in a Synuclein monomer deposition in Lewy body