Dementia

Question 1

What is it

Answer 1

Symptoms fall into 3 groups;
• Cognitive impairment (difficulties with memory, language, attention, thinking, calculation and problem solving)
• Psychiatric or behavioural disturbances (changes in personality, emotional control and social behaviour)
• Difficulties with activities of daily living

Question 2

How common is it

Answer 2

• 800,000 people in UK

* 1/3 over 65yrs will develop

Question 3

Who gets it

Answer 3

• M

Question 4

What are the causes of dementia

Answer 4

Alzheimers – 50%

• degeneration of cerebral cortex with cortical atrophy, neurofibrillary tangles, amyloid plaque formation and reduction in ACh production in affected neurones
• Cerebral cortex (grey matter) shrinks

Vascular dementia- 25%
- Brain damage due to cerebrovascular disease, major stroke, multi-infarcts or chronic changes in smaller vessels (subcortical dementia)

Dementia with Lewy bodies (DLB) -15%
- Deposition of abnormal protein within neurones in the brain + neocortex. Small circular lumps of protein that develop within brain cells

Frontotemporal dementia- <5%
- specific degeneration/ atrophy of the frontal + temporal lobes of brain. E.g. picks disease. Many cases it is an inherited genetic mutation (motor neurone disease, sometimes associated)

• Mixed dementia
• Parkinson’s disease

Possibly treatable dementias; substance abuse, hypothyroidism, normal pressure hydrocephalus, syphilis, vit B12 def, folate def

Question 5

What are the risk factors

Answer 5

• Age
• FHx – frontotemporal
• HTN
• Hypercholesterolemia
• Over weight
• High alcohol
• Smoking
• VASCULAR DEMENTIA diabetes, HTN, hyperlipidaemia, obesity, smoking

Question 6

How does it present

Answer 6

• Cognitive impairment memory, language, attention, thinking, orientation, calculation, problem-solving
• Psychiatric or behavioural disturbances – changes in personality, emotional control, social behaviour, depression, agitation, hallucination, delusion
• Difficulties in daily life activities
• ALZHEIMER’S insidious onset
• VASCULAR typically series of stepwise increases in severity
• LEWY BODY fluctuating consciousness, hallucinations, sleep disorders
• PARKINSON’S parkinson’s symptoms precede dementia
• FRONTOTEMPORAL changes in personality + language disturbances

Question 7

What are the signs

Answer 7

• Hx of memory problems
• Poor score of MMSE (30) or AMTS (10)
• Assesses long/short term memory, attention span, concentration, language + communication skills, ability to plan + understand instructions

Question 8

What are the investigations

Answer 8

• Look for treatable causes FBC, ESR, CRP, MSU, U&E, LFT, glucose, Ca2+, TFT, B12 + folate
• Mini mental state examination / Abbreviated mental test score
• BRAIN SCAN –> CT + MRI
• Perfusion hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) distinguish Alzheimer’s, vascular, frontotemporal dementia
• CSF exam –> creutzfeldt-jakob disease or other forms rapidly progressive dementia
• EEG –> check electrical signals in brain

Question 9

What is the treatment

Answer 9

NON-PHARM
- Cognitive stimulation, multisensory stimulation, music + art therapy, dancing, massage

PHARM
- Aricept (DONEPEZIL) + other ACEis (galantmine + rivastigmine) mild to mod Alzheimer’s + help w/ hallucinations in Lewy Body
SE: nausea + vomiting
- Memantine hydrochloride – blocks chemical in brain sev Alzheimer’s
- Antipsychotics – if behaviour disruptive
SE: can CV problems, cause drowsiness. In those w/ Lewy body = rigidity, immobility, inability to communication
- Anti-depressants

THERAPY
- Cognitive stimulation + reality orientation therapy validation (dementia from emotional rather than factual basis)