Dementia

Question 1

What is dementia?

Answer 1

A clinical syndrome of progressive cognitive impairment that affects daily function and independence.

Question 2

What are the most common causes of dementia in the UK?

Answer 2

The most common causes of dementia in the UK are:
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
These conditions may coexist.

Question 3

What are some difficulties in diagnosing dementia?

Answer 3

Diagnosis can be difficult and is often delayed. Assessment tools are used to aid in diagnosis, and certain tools are recommended by NICE for non-specialist settings.

Question 4

What assessment tools does NICE recommend for dementia in the non-specialist setting?

Answer 4

NICE recommends the following assessment tools:
- 10-point cognitive screener (10-CS)
- 6-Item cognitive impairment test (6CIT)

Question 5

What assessment tools does NICE not recommend for dementia in the non-specialist setting?

Answer 5

NICE does not recommend the following assessment tools:
- Abbreviated mental test score (AMTS)
- General practitioner assessment of cognition (GPCOG)
- Mini-mental state examination (MMSE)
However, an MMSE score of 24 or less out of 30 suggests dementia.

Question 6

What tests are recommended by NICE to exclude reversible causes of dementia in primary care?

Answer 6

NICE recommends the following tests in primary care:
- FBC (Full Blood Count)
- U&E (Urea & Electrolytes)
- LFTs (Liver Function Tests)
- Calcium
- Glucose
- ESR/CRP (Erythrocyte Sedimentation Rate/C-Reactive Protein)
- TFTs (Thyroid Function Tests)
- Vitamin B12 and folate levels

Question 7

What is the role of neuroimaging in secondary care for dementia?

Answer 7

In secondary care, neuroimaging is used to:
- Exclude other reversible conditions (e.g., subdural haematoma, normal pressure hydrocephalus)
- Provide information on aetiology, prognosis, and management.

Question 8

According to the 2018 NICE guidelines, when should structural imaging be offered for dementia?

Answer 8

Structural imaging should be offered to:
- Exclude reversible causes of cognitive decline
- Assist with subtype diagnosis unless dementia is well established and the subtype is clear.

Question 9

Where are patients with dementia commonly referred for specialized care?

Answer 9

Memory clinics, which are often led by old-age psychiatrists or geriatricians

Question 10

What are the common causes of dementia?

Answer 10

• Alzheimer’s disease
• Cerebrovascular disease (multi-infarct dementia) - approximately 10-20%
• Lewy body dementia - approximately 10-20%

Question 11

What are some rarer causes of dementia?

Answer 11

Rarer causes account for approximately 5% of cases and include:
- Huntington’s disease
- Creutzfeldt-Jakob disease (CJD)
- Pick’s disease (atrophy of frontal and temporal lobes)
- HIV (50% of AIDS patients)

Question 12

What are some important differential diagnoses for dementia that are potentially treatable?

Answer 12

Potentially treatable causes include:
- Hypothyroidism
- Addison’s disease
- B12/folate/thiamine deficiency
- Syphilis
- Brain tumor
- Normal pressure hydrocephalus
- Subdural haematoma
- Depression
- Chronic drug use (e.g., alcohol, barbiturates)