Dementia

Question 1

True or false: dementia is a normal part of aging

Answer 1

False

Question 2

Give the definition of dementia:

Answer 2

an irreversible and progressive decline in more than one aspect of higher brain function (concentration, memory, language, personality, emotion)

Question 3

What is the only way in which a dementia diagnosis can be proven?

Answer 3

post-mortem with histological evidence

Question 4

What three steps are used to diagnose dementia?

Answer 4

1) history
2) cognitive assessments
3) neuropsychological assessments

Question 5

Give 4 types of dementia:

Answer 5

1) Alzheimer’s dementia
2) Vascular dementia
3) Lewy Body dementia
4) frontotemporal dementia

Question 6

What is the most common type of dementia?

Answer 6

Alzheimer’s dementia

Question 7

What causes Alzheimer’s dementia?

Answer 7

the accumulation of amyloid plaques (beta-amyloid) and neurofibrillary tangles leading to a reduction in information transmission and eventually the death of brain cells

Question 8

What are neurofibrillary tangles?

Answer 8

bundles of filaments within neurons mostly made from tau protein

Question 9

Give 2 clinical presentations associated with Alzheimer’s:

Answer 9

1) memory loss
2) changes in planning, reasoning, speech and orientation

Question 10

True or false: Alzheimer’s dementia can affect all areas of the brain

Answer 10

True

Question 11

What is the second most common type of dementia?

Answer 11

Vascular dementia

Question 12

Is vascular dementia more common in males or females?

Answer 12

males (due to their increased risk of vascular disease)

Question 13

Describe the natural history (progression) of vascular dementia:

Answer 13

vascular dementia progresses in a stepwise fashion where there is a period of stability followed by an acute decline followed by a period of stability

Question 14

What is the most common cause of vascular dementia?

Answer 14

cerebrovascular infarcts

Question 15

Give 4 brain regions that are most commonly affected by vascular dementia:

Answer 15

1) white matter of the cerebral hemispheres
2) thalamus
3) striatum
4) grey nuclei

Question 16

Give 6 risk factors for vascular dementia:

Answer 16

1) hypertension
2) smoking
3) diabetes
4) hyperlipidaemia
5) obesity
6) hypercholesterolaemia

Question 17

Give 3 clinical features of vascular dementia:

Answer 17

1) cognitive impairment
2) mood disturbances and mood disorders
3) psychosis, delusions, hallucinations and paranoia

Question 18

What type of dementia is associated with mood disorders?

Answer 18

vascular dementia (all patients should be screened for depression)

Question 19

What is the life expectancy following diagnosis of Lewy Body Dementia?

Answer 19

7 years

Question 20

What causes Lewy Body dementia?

Answer 20

the deposition of spherical lewy body proteins

Question 21

What are Lewy body proteins?

Answer 21

aggregations of alpha-synuclein

Question 22

Describe the distribution of Lewy body proteins in Parkinson’s disease:

Answer 22

localised in the substantia nigra

Question 23

Describe the distribution of Lewy body proteins in Lewy body dementia:

Answer 23

widespread throughout the brain

Question 24

Give 5 clinical features associated with Lewy body dementia:

Answer 24

1) visual hallucinations
2) Parkinson-like symptoms
3) problems with multitasking
4) problems performing cognitive actions
5) sleep disorders

Question 25

True or false: memory loss is less common in Lewy body dementia

Answer 25

True

Question 26

Which type of dementia is associated with Parkinson-like symptoms?

Answer 26

Lewy body dementia

Question 27

How is Parkinson’s disease distinguished from Lewy Body dementia?

Answer 27

if physical symptoms precede cognitive decline by more than a year, the diagnosis if likely Parkinson’s with cognitive decline

Question 28

True or false: frontotemporal dementia affects a significant number of under 65s

Answer 28

True

Question 29

What is the average life expectancy for frontotemporal dementia following diagnosis?

Answer 29

8 years

Question 30

What causes frontotemporal dementia?

Answer 30

atrophy of the frontal and temporal lobes due to deposition of abnormal proteins (often tau protein)

Question 31

What are the three categories of clinical pictures seen in frontotemporal dementia?

Answer 31

1) behavioural
2) semantic
3) non-fluent

Question 32

Give 5 of the behavioural presentations associated with frontotemporal dementia:

Answer 32

1) altered emotional responsiveness (apathy, disinhibition, impulsivity)
2) progressive decline in interpersonal skills
3) changes in food preference
4) more childlike amusements
5) an attachment to obsessions and rituals

Question 33

Give 4 of the semantic presentations associated with frontotemporal dementia:

Answer 33

1) progressive decline in the understanding of words
2) difficulty in name retrieval and use of less precise terms
3) unable to determine the meanings of common words when asked
4) inability to recognise objects or familiar faces (prosopagnosia)

Question 34

What is prosopagnosia?

Answer 34

inability to recognise faces

Question 35

Give 4 of the non-fluent presentations associated with frontotemporal dementia:

Answer 35

1) progressive breakdown in the output of language
2) the speech takes effort and is not fluent
3) speech apraxia and disorders of speech sound
4) impaired comprehension of sentences and poor literacy skills

Question 36

What is speech apraxia?

Answer 36

poor articulation

Question 37

Give 4 differential diagnoses for memory loss and cognitive decline other than dementia:

Answer 37

1) Creutzfeldt Jacob Disease
2) HIV-related cognitive impairment/ dementia
3) normal pressure hydrocephalus
4) severe depression

Question 38

When would the term “mild cognitive impairment” be used?

Answer 38

for people with memory problems or high cortical thinking problems that are not severe enough to interfere with every day life

Question 39

Give 4 causes of mild cognitive impairment:

Answer 39

1) stress
2) strokes
3) depression
4) physical illness