Dementia

Question 1

What are the different types of dementia?

Answer 1

Mild cognitive impairment
Deficit in cognition and memory that is greater than expected with age

Not significant enough for a diagnosis of dementia

Alzheimers
Most common type
Brain atrophy, amyloid plaques, reduced cholinergic activity

Vascular dementia
Vascular damage and impaired blood supply to brain, same risk factors for CVD

Lewy body dementia
Parkinson like features 12 months before cognitive decline

Frontotemporal dementia
Pick’s disease, affects younger people 40-60

Mainly affects frontal and temporal lobes, abnormalities in behaviour, speech and language

Question 2

What medications are particularly known for their anticholinergic effects?

Answer 2

Anticholinergic urological drugs (oxybutynin, tolterodine)
Antihistamines (chlorphenamine and promethazine)
Tricyclic antidepressants (amitriptyline)

Question 3

What psychiatric conditions are differentials for dementia?

Answer 3

Depression
Psychosis
Delirium

Question 4

What neurological conditions are differentials for dementia?

Answer 4

Brain tumours (particularly affecting frontal lobe)
Parkinson’s
Huntington’s
Progressive supranuclear palsy

Question 5

What endocrine conditions are differentials for dementia?

Answer 5

Hypothyroidism
Adrenal insufficiency
Cushing’s syndrome
Hyperparathyroidism
Vitamin B12 deficiency
Thiamine deficiency causing WK syndrome

Question 6

What are some modifiable lifestyle factors that can reduce the risk of developing dementia?

Answer 6

Exercise
Mental stimulation
Healthy weight
BP control
Blood glucose control

Question 7

How does dementia present?

Answer 7

Forgetful
Difficulty with words
Repeating same questions
Reduced flexibility
Impaired decision making

Question 8

What are the features of advanced dementia?

Answer 8

Aphasia-inability to speak or understand speech
Dysphagia- leading to aspiration and pneumonia
Appetite and weight loss
Incontinence

Question 9

What screening tests can be used for dementia?

Answer 9

General practitioner assessment of cognition (GPCOG)
Six item cognitive impairment test
10 point cognitive screener

Question 10

What investigations are done in query dementia?

Answer 10

FBC
U&Es
LFTS
CRP and ESR
TFTs
Calcium
HbA1c
B12 and folate

Mid-stream urine if infection suspected
CXR

MRI brain

Question 11

What is ACE-III?

Answer 11

Addenbrooke’s cognitive examination-III

Detailed and comprehensive assessment tool for memory impairment

Question 12

What domains are tested in ACE-III?

Answer 12

Attention
Memory
Language
Visuospatial function
Verbal fluency

Scored out of 100
88 or less indicates possible dementia

Question 13

How is dementia managed?

Answer 13

Progressive, not curable

Support patients and carers in coping with symptoms

Planning ahead
- Lasting power of attorney
- Advanced decisions
- Planning future care

Question 14

What medications can be given for Alzheimer’s disease?

Answer 14

AChEis
- Donepezil
- Rivastigmine
- Galantamine

NMDA receptor antagonists
- Memantine

Question 15

What are the behaviour and psychological symptoms of dementia?

Answer 15

Depression
Anxiety
Agitation
Aggression
Disinhibition
Hallucinations
Delusions
Sleep disturbance

Question 16

How are the behavioural and psychological symptoms of dementia managed?

Answer 16

Treat underlying causes
Remove triggers
Trained carers
Supervision

Question 17

What is normal pressure hydrocephalus?

Answer 17

Increased size of the ventricular system causing compression of local brain structures

Question 18

What are the symptoms of normal pressure hydrocephalus?

Answer 18

Wet- Urinary incontinence
Wobbly- Gait dysfunction
Wacky- Dementia

Question 19

What is the first-line investigation for normal pressure hydrocephalus?

Answer 19

Lumpar puncture

(if relieves pressure a ventriculoperitoneal shunt would be inserted)