Dementia

Question 1

Why is it hard to accurately diagnose dementia?

Answer 1

• heterogenous course
• many presentations overlap with other co-morbidities

Question 2

What is included in a clinical interview?

Answer 2

• memory
• language
• numerical skills
• executive skills
• visuospatial skills
• neglect phenomena
• visual perception
• landmark identification
• personality
• sexual behaviour
• eating
• mood
• apathy
• anxiety/agitation
• delusions/hallucinations

Question 3

What is important when doing a clinical interview?

Answer 3

to interview patients and their collateral (who came in with them, etc.)

Question 4

What is dementia?

Answer 4

severe loss of memory and other cognitive abilities which leads to impaired daily function (irrelevant of the underlying cause)

Question 5

What investigations should be done to diagnose dementia?

Answer 5

• Bloods (CSF and plasma marker)
• MRI
• PET
• Neuropsychology

Question 6

What exams should be done during an examination for dementia?

Answer 6

• MMSE
• +/- ACE III

Question 7

What bloods should be run for a dementia diagnosis?

Answer 7

• FBC
• Inflammatory markers
• TFTs
• Biochemistry and renal function
• Glucose
• B12 and folate
• Clotting
• HIV
• Syphilis serology
• Caeruloplasmin

Question 8

What are the possible differentials for the presenting symptoms?

Answer 8

• Alzheimer’s disease
• Vascular dementia
• Lewy Body dementia
• Frontotemporal dementia
• Depression
• Delirium

Question 9

What is the general management plan for these symptoms?

Answer 9

• Acetylcholinesterase inhibitors
• Treat the behavioural/psychological symptoms
• OT/social services
• Specialist therapies

Question 10

How does Alzheimer’s present?

Answer 10

• subtle
• insidious amnestic/non-amnestic presentations

Question 11

How does Vascular dementia present?

Answer 11

related to cerebrovascular diseases with step-wise deterioration +/- multiple infarcts

Question 12

How does Lewy Body Dementia present?

Answer 12

• cognitive impairment within 1 year of Parkinsonism symptoms
• visual hallucinations
• fluctuating cognition

Question 13

How does frontotemporal dementia present?

Answer 13

• behaviour variant
• semantic dementia
• progressive non-fluent aphasia

Question 14

What would be present in a case of probable Alzheimer’s?

Answer 14

• asks the same questions everyday
• mistakes with taking medication
• can drive, but struggles with directions
• can rewatch the same shows
• increasingly irritable

Question 15

How to see Alzheimer’s on an MRI?

Answer 15

• bigger gaps in the brain
• larger, darker hippocami

Question 16

What biomarkers are high in those with dementia?

Answer 16

• A beta Amyloid
• Tau mediated Neuronal Injury and Dysfunction

Question 17

What is Alzheimer’s disease?

Answer 17

• most common neurodegenerative dementia
• initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures

Question 18

What in an examination would indicate Lewy Body dementia?

Answer 18

• awareness of recent news
• no altered behavious
• good MMSE (errors on attention)
• evidence of parkinsonism not always present
• daily visual hallucinations

Question 19

What are the characterisitics of Lewy Body dementia?

Answer 19

• associated with fluctuating cognition
• often visual hallucinations
• REM sleep disorder
• Parkinsonism
• High fall risk

Question 20

How to identify Lewy Body dementia on a scan?

Answer 20

PET: smaller, duller spot due to less uptake
MRI: more grey matter in the hippocampi

Question 21

What is typical of Frontotemporal dementia?

Answer 21

• memory problems
• speech deterioration
• anomia
• irritable and agitation
• mood changes

Question 22

How can you identify Frontotemporal dementia on a scan?

Answer 22

volume loss in temporal lobes and frontal opercula