dementia

Question 1

what are some risk factors for alzheimer’s disease ?

Answer 1

increasing age
family history
caucasian ethnicity
down’s sydnrome

Question 2

what are some pathological changes in Alzheimer’s disease ?

Answer 2

macroscopic - widespread cerebral atrophy

microscopic - cortical plaques due to deposition of amyloid protein

biochemical - deficit of ach from damage

Question 3

what is the non-pharmacological management of alzheimer’s disease ?

Answer 3

activities to promote wellbeing
cognitive stimulation therapy

Question 4

what are some pharmacological management options of Alzheimer’s disease ?

Answer 4

• 3 acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine
• memantine

Question 5

what can be given to manage non-cognitive symptoms in Alzheimer’s disease ?

Answer 5

antidepressants for mild to moderate depression

anti-psychotics if risk of harming self

Question 6

what is donepezil contra-indicated in ?

Answer 6

bradycardia

Question 7

what are some factors that favour delirium over dementia ?

Answer 7

acute onset
impairment of consciousness
fluctuation of symptoms
abnormal perception
agitation
delusions

Question 8

what is the most common cause of dementia in the UK ?

Answer 8

alzheimer’s disease

Question 9

what are the causes of dementia ?

Answer 9

alzheimer’s disease
cerebrovascular disease
lewy body disease

rare -
huntington’s
CJD
HIV

Question 10

what are some potentially treatable differentials of dementia ?

Answer 10

hypothyroidism
B12 / folate / thiamine deficiency
syphilis
brain tumour
normal pressure hydrocephalus
depression

Question 11

what are some investigations of dementia ?

Answer 11

a blood screen - exclude reversible causes - FBC, U&E’s, LFTs, calcium, glucose, ESR/CRP, TFT’s, vitamin b12
neuroimaging

Question 12

what are the common features of frontotemporal lobar dementia ?

Answer 12

onset 65
insidious onset
personality change
impaired social conduct
disinhibition
increased appetite
perseveration behaviours

Question 13

what are the macroscopic changes of frontotemporal dementia ?

Answer 13

atrophy of frontal and temporal lobes

Question 14

what are the microscopic changes of frontotemporal dementia ?

Answer 14

pick bodies
gliosis
neurofibrillary tangles
senile plaques

Question 15

what is lewy body dementia ?

Answer 15

characteristic feature is alpha-synuclein cytoplasmic inclusions in the substantia nigra, paralimbic and neocortical areas.

Question 16

what are the features of lewy body dementia ?

Answer 16

progressive cognitive impairment
parkinsonism
visual hallucinations

Question 17

what condition is associated with lewy body dementia ?

Answer 17

parkinsons disease

Question 18

how is a diagnosis of lewy body dementia made ?

Answer 18

clinical
single-photon emission computed tomography

Question 19

what is the management of lewy body dementia ?

Answer 19

ach inhibitors and memantine

Question 20

what medications should be avoided in lewy body dementia ?

Answer 20

neuroleptics should be avoided

Question 21

what is vascular dementia ?

Answer 21

not a single disease but a group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease

Question 22

what are some risk factors for vascular dementia ?

Answer 22

history of stroke or TIA
AF
DM
hyperlipidaemia
smoking
obesity
coronary heart disease

Question 23

what are some symptoms of vascular dementia ?

Answer 23

focal neurological abnormalities - visual disturbance
difficulty with attention and concentration
memory disturbance
gait disturbance
speech disturbance
emotional disturbance

Question 24

how is a diagnosis of vascular dementia made ?

Answer 24

comprehensive history and physical examination
formal screen for cognitive impairment
medical review
MRI scan

Question 25

what are the guidelines that NICE recommend for diagnosing someone with vascular dementia ?

Answer 25

- presence of cognitive decline that interferes with daily lifestyle - cerebrovascular disease relationship between the 2

Question 26

what is the non-pharmacological management of vascular dementia ?

Answer 26

tailored to the individual cognitive simulation programmes music and art therapy managing challenging behaviours

Question 27

what is the pharmacological management of vascular dementia ?

Answer 27

no specific only consider AChE inhibitors or memantine for people with co-morbid dementia

Question 28

what are some predisposing factors for delirium ?

Answer 28

over 65 years old background of dementia significant injury frailty or comorbidity polypharmacy

Question 29

what are some predisposing events for delirium ?

Answer 29

infection -UTI metabolic - hypercalcaemia, hypoglycaemia, dehydration change of environment severe pain alcohol withdrawal constipation

Question 30

what are some features of delirium ?

Answer 30

memory disturbance agitated disorientation mood change visual hallucinations disturbed sleep cycle poor attention

Question 31

what is the management of delirium ?

Answer 31

treat underlying cause modify environment first line sedative - haloperidol 0.5mg

Question 32

in what condition are anti-psychotics challenging in ?

Answer 32

parkinson's disease

Question 33

what drugs can cause delirium ?

Answer 33

anti-depressants anti-psychotics benzodiazepines anti-parkinsonian drugs anticholinergic drugs opiates diuretics recreational drug intoxication and withdrawal

Question 34

what are some causes of delirium ?

Answer 34

trauma hypoxia increasing age/frailty NOF fracture smoker drugs change in environment lack of sleep imbalance of electrolytes urinary retention infection uncontrolled pain medical conditions - dementia, parkinsons disease