dementia

Question 1

most common causes

Answer 1

Alzheimer’s
vascular
Lewy body

Question 1

blood screen

Answer 1

FBC, U+E, LFT, Calcium, glucose, ESR,CRP, TFT’s vitamin B12 and folate

Question 2

when is neuroimaging performed

Answer 2

secondary care to assess for reversible causes like subdural haematomas, normal pressure hydrocephalus

Question 3

vascular dementia

Answer 3

group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease.

Question 4

Patients with VD typically presents with

Answer 4

Several months or several years of a history of a sudden or stepwise deterioration of cognitive function

Question 5

MRI scan - vascular dementia

Answer 5

infarcts and extensive white matter changes

Question 6

when are AChe inhibitors used in the management of vascular dementia

Answer 6

suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.

Question 7

Factors suggesting diagnosis of depression over dementia

Answer 7

short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)

Question 8

levy body - pathological feature

Answer 8

alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.

Question 9

features - Lewy body

Answer 9

progressive cognitive impairment
with cognition loss before Parkinson’s signs
visual hallucinations

Question 10

diagnosis of lewy-body dementia

Answer 10

usually clinical
single-photon emission computed tomography (SPECT) is increasingly used.

Question 11

medical mx of lewy body dementia

Answer 11

acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine

Question 12

features of fronto-temporal dementia

Answer 12

<65
insidious onset
preserved memory and visuospatial skills
personality change and social conduct problems

Question 13

picks disease

Answer 13

most common form of fronto-temporal dementia

Question 14

Macroscopic changes seen in Pick’s disease include:-

Answer 14

Atrophy of the frontal and temporal lobes

Question 15

Microscopic changes include:-

Answer 15

Pick bodies - spherical aggregations of tau protein (silver-staining)
Gliosis
Neurofibrillary tangles
Senile plaques

Question 16

semantic dementia

Answer 16

progressive aphasia

Question 17

CPA

Answer 17

non fluent speech

Question 18

Alzheimer’s pathological changes

Answer 18

widespread cerebral atrophy, particularly involving the cortex and hippocampus
cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein

Question 19

medications for management

Answer 19

the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease
memantine (an NMDA receptor antagonist) is in simple terms the ‘second-line’

Question 20

donepezil s/e

Answer 20

c/i in bradycardia
adverse effects : insomnia

Question 21

reversible causes

Answer 21

B12, thiamine def, normal pressure hydrocephalus, uraemia, hypothyroidism , hypoglycaemia

Answer 22

Duloxetine is an SNRI, so inhibits the reuptake of noradrenaline
(NA) at the synapse, meaning there is increased NA available, and
this increases the tone of the internal urethral sphincter.