Dementia

Question 1

List 8 causes of dementia.

What mnemonic can you use to remember this?

Answer 1

VITAMINS:

Vascular
Infectious
Toxic/metabolic causes (e.g. thyroid)
Autoimmune encaphalitis
Metastatic/neoplastic disease
Iatrogenic/inborn errors of metabolism
Neurodegenerative disease
Systemic/seizures

Question 2

Describe the DSM4 diagnostic criteria for dementia. (8)

Answer 2

Memory impairment

At least 1 of:

• Executive dysfunction
• Language disorder
• Apraxia
• Visuospatial dysfunction

Deficits impact on social/occupational function
Onset is gradual and progressive
Cognitive features are NOT caused by delirium/medications/other illnesses

Question 3

Which tests can you do to assess cognitive function? (4)

Answer 3

AMT (abbreviated mental test)
MMSE/MOCA
ACE-R
Neuropsychology input

Question 4

Describe how to do an abbreviated mental test (AMT). (10)

Answer 4

How old are you?
What time is it? (to the nearest hour)
Give patient an address to remember until the end of the test
What year is it?
Where are we right now?
Identification of 2 nearby people
What is your date of birth?
Can you tell me the year WW2 started?
Can you tell me what the prime minister is called?
Can you count back from 20 to 1?
Can you remember the address I told you earlier?

1 point for each correct answer

Question 5

List 3 causes of Alzheimer’s disease.

Answer 5

Genetic predisposition
Environmental triggers
Accumulation of beta amyloid plaques

Question 6

Describe the 4 main clinical features of Alzheimer’s disease.

Answer 6

Memory loss
Language dysfunction
Abnormal behaviour/judgement
Visuospatial defects

Question 7

Give 2 examples of language dysfunction in Alzheimer’s disease.

Answer 7

Nominal dysphasia (word finding difficulties)
Logopenic dysphasia (inability naming objects)

Question 8

List 8 examples of abnormal behaviour in Alzheimer’s disease.

Answer 8

Disinhibition
Euphoria
Loss of social awareness
Abulia (lack of willpower)
Apathy
Akinetic mutism
Difficulty planning
Difficulty understanding proverbs

Question 9

List 7 examples of visuospatial dysfunction in Alzheimer’s disease.

Answer 9

Dyspraxia
Difficulty in picking objects from a scene
Visual agnosia (inability to recognise objects)
Prosopagnosia (inability to recognise faces)
Visual neglect/inattention
Apraxia
Optic ataxia/simultanagnosia

Question 10

How would you test for apraxia? (2)

Answer 10

Clock drawing test

Ask patient to copy shapes

Question 11

What investigations would you do for Alzheimer’s? (6)

Answer 11

Cognitive function

Medication review

Bloods:

• Thyroid function tests
• Folate/B12

CT/MRI:

• Tumours
• Haematomas
• Vascular dementia

Depression screening

DSM4 diagnostic criteria

Question 12

How would you manage Alzheimer’s disease? (8)

Answer 12

Acetylocholinesterase inhibitors
Anti-glutamatergic drugs
BP control
Folic acid/vitamin supplements

Psychological treatment:

• Validation therapy
• Behavioural therapy

Other management:

• Environmental control measures
• Social worker involvement

Question 13

List 3 examples of anti-cholinesterase drugs.

Answer 13

Donepezil
Rivastigmine
Galantamine

Question 14

List 1 example of an anti-glutamatergic drug.

Answer 14

Memantine

Question 15

List 3 types of amnestic syndrome.

Answer 15

Hippcampal/mesial temporal lobe amnesia
Mammillary body/thalamus dysfunction
Thalamus dysfunction

Question 16

List 4 causes of hippocampal amnesia.

Answer 16

Alzheimer’s
Limbic encephalitis
Herpes simplex encephalitis
Post-hypoxic injury

Question 17

List 1 cause of mammillary body/thalamus dysfunction.

List 1 cause of thalamus dysfunction.

Answer 17

Korsakoff’s psychosis

Infarction