Dementia

Question 1

For each of the main causes of dementia, what are some clues that would help differentiate between them?

Answer 1

AD: Memory impairment predominates early in the absence of other physical signs

Vascular Dementia: Stepwise decline, hx of cerebrovascular disease, focal neurological signs depending on insult, and behavioural withdrawal, infarcts on MRI

Frontotemporal Dementia: Inhibition, cortical release signs

Lewy Body: Vivid visual hallucinations occur, Parkinsonian features, inter/intra-day fluctuation

Question 2

What are the five cardinal features for diagnosis of dementia?

Answer 2

• Cognitive decline - memory, language, executive function, praxia, visuospatial function
• Chronic and progressive
• Impairment to social and/or occupational function
• Decline from previous level of function
• The diagnosis cannot be make concurrent to depression or delirium

Question 3

What is agnosia?

Answer 3

Inability to interpret sensations and hence to recognize things, typically as a result of brain damage.

Question 4

What conditions can resemble dementia?

Answer 4

Normal ageing process
Mild cognitive impairment
Depression
Delirium
Intellectual disability

Question 5

What proportion of dementia is caused by the four must common causes?

Answer 5

AD: 50-70%
Vasc: 10-20%
FLD
Lewy Body dementia

Question 6

What are some risk factors for dementia?

Answer 6

Age
Down syndrome
Genetic predisposition (Apolipoprotein E4)
Cerebrovascular rf: HTN, hyperchol, smoking, DM, obesity
Head injury

Question 7

What are some protective factors?

Answer 7

Physical exercise
Social engagement
High intellectual capacity