Dementia

Question 1

How prevalent is Dementia?

Answer 1

> 85 y/o - 1 in 5
75 y/o - 1 in 10
65 y/o - 1 in 20
More than half have Alzheimer’s disease

Question 2

What are some of the common types of Dementia?

Answer 2

Alzheimer’s disease - Global + progressive
Vascular - Patchy
Lewy body - Parkinsonian
Creutzfeldt-Jakob disease (Prion disease)
Fronto-temporal dementia (Pick’s disease)
AIDS dementia

Question 3

What are some of the reversible types of Dementia?

Answer 3

Chronic alcohol abuse
Deficiencies eg B12, Thiamine, T4
Infection eg Syphillis
Neoplastic - Frontal lobe tumours

Question 4

What are some of the risk factors for Dementia?

Answer 4

Genetic - Apolipoprotein E (APOE)
Vascular
Psychsocial - Nutritional (Diet high in sat fats + Cholesterol), Lower education, Poor social network/Lack of social engagement

Question 5

What is the vascular hypothesis for Dementia?

Answer 5

Smoking
Alcohol
Being overweight
High total cholesterol
DM
Cardiovascular/Cerebrovascular disease

Question 6

What are some of the protective factors for Dementia?

Answer 6

Diet - Antioxidants eg Vit E + C, fish, veg, fruit, poly unsaturated fats
Physical activity
Mental activity eg reading, socialising
More complex work - high level of complex mental activity across lifespan correlated with reduced hippocampal atrophy

Question 7

What is the pathophysiology of Vascular dementia?

Answer 7

Arteriosclerosis of blood vessels
Occlusive neuronal death
Involves large + small blood vessels
Emboli
Vasculitis
Haemorrhages

Question 8

What are some of the features of Vascular dementia?

Answer 8

Memory + cognitive impairment
Emotional + behavioural disturbances
Uneven distribution of deficits
O/E - Plantar reflex extension, Unilateral limb UMN deficit - Focal neurological deficits*

Question 9

What are the features of Lewy body dementia?

Answer 9

Visual hallucinations
Parkinsonism
Fluctuating memory + cognitive impairment

Question 10

What is the pathophysiology of Lewy body dementia?

Answer 10

Lewy bodies (Protein) accumulate in the brain
Alpha synuclein + ubiquitin
Cerebral + Substantia Nigra

Question 11

What other neurological disease are Lewy bodies present in?

Answer 11

Parkinson’s disease

Question 12

What are the requirements to have a diagnosis of Dementia?

Answer 12

6 months or more of;
Decline in cognitive function
Decline in memory
Preserved awareness of the environment
Decline in emotional control/motivation or changes in social behaviour

Question 13

How can you assess Dementia in a patient?

Answer 13

Speak to relatives/carers
Personal history + family history
Medical history + medications
Substance use history
Social history - living conditions, finances
Functional history - mobility, ADL, continence
MSE!

Question 14

What investigations should be done in a patient with Dementia?

Answer 14

FBC
TFTs
B12 + folate
U+Es
LFTs
CRP
CT/MRI of brain
EEG
Syphilis serology
HIV test
Heavy metals testing
*Dependent on history, may do CXR*

Question 15

What is the Primary prevention for Dementia?

Answer 15

Vascular and lifestyle factors are modifiable

Focus on maintain an active and social lifestyle

Question 16

Define Dementia

Answer 16

A group of neurodegenerative diseases that result in a progressive decline in global cognition with no impairment in consciousness

Question 17

What is Pick’s dementia?

Answer 17

Fronto-temporal atrophy causing change in personality, loss of inhibition, progressive non fluent aphasia, somantic dementia (Loss of meaning)
Earlier onset than other dementias

Question 18

What is the treatment for dementia?

Answer 18

Acetylcholinesterase inhibitors eg Rivistigmine, Donepezil, Galantamine
NMDA receptor antagonists eg Memantine

Question 19

What is BPSD?

Answer 19

Behavioural psychiatric symptoms in dementia
Occurs in majority of dementia patients
Treat by keeping patients in a calm environment, engaging with them, having familiar surroundings/people. Try to avoid sedation, can use antipsychotic short term