Dementia

Question 1

What is dementia?

Answer 1

Progressive impairment of multiple domains of cognitive function in alert patients leading to loss of acquired skills and interference in occupational and social roles

Question 2

What is meant by late onset of dementia?

Answer 2

Developing dementia after the age of 65

Question 3

What is meant by a young onset of dementia?

Answer 3

Developing dementia before the age of 65

Question 4

What is the most common type of dementia?

Answer 4

Alzheimer’s

Question 5

Which genetic condition may lead to early onset of dementia?

Answer 5

Huntington’s

Question 6

Which infections can lead to early onset of dementia?

Answer 6

HIV
CJD (Creutzfeldt-Jakob disease)

Question 7

Which inflammatory disorder can lead to early onset of dementia?

Answer 7

MS

Question 8

Which toxin can lead to early onset of dementia?

Answer 8

Alcohol

Question 9

There re some causes of dementia which are treatable. Which vitamin deficiency can be treated to also treat dementia?

Answer 9

Vitamin B12

Question 10

What are some endocrine causes of dementia which can be treated?

Answer 10

Thyroid disease

Question 11

What are some infections which can cause dementia but can be treated?

Answer 11

HIV
Syphilis

Question 12

What are some issues which can mimic dementia?

Answer 12

Hydrocephalus
Tumour
Depression

Question 13

Why may depression get confused with dementia?

Answer 13

Sometimes depression can lead to problems with alertness, concentration and attention and may be difficult to retain information.

Question 14

In examination of those with dementia, which examinations would be carried out?

Answer 14

Cognitive function
Neurological
Vascular- some types of dementia are of vascular causes

Question 15

Which investigations are routinely carried out in those with suspected dementia?

Answer 15

Bloods
CT/MRI

Question 16

Other tests can be done to rule out other mimics/causes of dementia. Which investigation would be done if you suspected CJD was the cause of the dementia?

Answer 16

ECG

Question 17

In Alzheimer’s, in which lobe of the brain would there hypometabolism?

Answer 17

Temporal lobe

Question 18

During an examination of cognitive functions, which domains are tested?

Answer 18

Memory, attention, language, visuospatial, behaviour, emotion, executive function, apraxia. agnosias

Question 19

Apraxia?

Answer 19

Difficulty to perform learned tasks

Question 20

Agosias?

Answer 20

Difficulty with interpreting sensory information e.g. difficulty recognising faces

Question 21

What are some of the screening tests used in the examination of cognitive function?

Answer 21

Mini Mental Exam (MMSE)
Montreal (MOCA)

Question 22

How is the type of dementia diagnosed?

Answer 22

Cannot get during life, only upon post-mortem examination of the brain

Question 23

If there was a rapid speed in the development of dementia, what do you think would be the cause?

Answer 23

CJD

Question 24

If there was a stepwise speed in the development of dementia, what do you think would be the cause?

Answer 24

Vascular dementia

Question 25

If there were abnormal movements or a movement disorder with the dementia, what could be the cause of the dementia?

Answer 25

Huntington's

Question 26

If dementia presented with symptoms of Parkinsonism, what could be the type of dementia?

Answer 26

Lewys body dementia

Question 27

If dementia also presented with myoclonus, what could be the cause of the dementia?

Answer 27

CJD

Question 28

What is the pathophysiology behind alzheimer's?

Answer 28

Beta-amyloid plaque deposition and neurofibrillary tangles

Question 29

What are some of the risk factors of Alzheimer's?

Answer 29

Genetics Environmental- smoking, obesity, hypertension, diabetes.

Question 30

Which factors would decrease risks of Alzheimer's?

Answer 30

Better cognitive reserve Good diet (especially Mediterranean diet!!! just for interest) Plenty of exercise

Question 31

Which lobes does Alzheimer's affect?

Answer 31

Temporal and parietal lobes

Question 32

What does the involvement of the temporal lobe in Alzheimer's lead to?

Answer 32

Early memory disturbance

Question 33

What happens in frontotemporal dementia?

Answer 33

Early change in personality / behaviour, which is often a late symptom of dementia.

Question 34

Which aspects are preserved in those with frontotemporal dementia?

Answer 34

Memory Visuospatial

Question 35

As the frontal lobes are affected in frontotemporal dementia, what can this lead to?

Answer 35

Changes in eating habits

Question 36

What is the pathology behind dementia with Lewy bodies?

Answer 36

Accumulation of abnormal alpha synuclein

Question 37

Which functions of the brain are disrupted in early stages of dementia with Lewy bodies?

Answer 37

Visuospatial Executive dysfunction

Question 38

What are some other symptoms of dementia with Lewy bodies?

Answer 38

Prominent fluctuation Parkinsonism

Question 39

Treatment of dementia is symptomatic treatment. What are some of the pharmacological treatments used to treat?

Answer 39

Insomnia Behaviour- care with antipyschotics Depression

Question 40

What are some of the non-pharmacological treatments for those with dementia?

Answer 40

Information and support from dementia services OT Social work

Question 41

What are some treatments specific for Alzheimer's dementia?

Answer 41

Cholinesterase inhibitors as there is cholinergic deficit -> donepezil, rivastigmine, galantamine NMDA antagonist -> mematine

Question 42

In which type of dementia may there be hallucinations?

Answer 42

Dementia with Lewy bodies

Question 43

A 70 year old man presents with progressive short-term memory impairment and is unable to recall when to take his medications and had unable to mange his financial affairs. On cognitive testing he has deficits in memory, visuospatial function and language abilities. What is the most likely diagnosis?

Answer 43

Alzheimer's dementia

Question 44

A 75-year-old woman presents with progressive deterioration in cognitive function. Her husband says that some days are much worse than others. She sees small animals or children in her house which aren't there. Cognitive assessment reveals deficits in all cognitive domains, particularly in executive function and visuospatial functioning. Neurological examination reveals mild rigidity and bradykinesia with a shuffling gait. What is the most likely diagnosis?

Answer 44

Dementia with Lewy bodies