Dementia

Question 1

What is Dementia?

Answer 1

A syndrome caused by a number of brain disorders resulting in Memory loss, decline in cognition and difficulties with activities of daily living

Question 2

What is the main cause of Dementia?

Answer 2

Alzheimer’s Disease which is caused by accumulation of Beta-Amyloid peptide which causes neurofibrillary tangles and loss of ACh

Question 3

Other causes of dementia (3)

Answer 3

VASCULAR-cumulative effect of many small strokes resulting in widespread infarcts, LEWY BODY-deposition of abnormal protein in the brainstem and neocortex causing fluctuating impairment, visual hallucinations and parkinsonism, FRONTO-TEMPORAL/PICKS-degeneration/atropy of the fronto-temporal region due to implications with chromosome 9, ALCOHOL, REPEATED HEAD TRAUMA, HUNTINGTONS, CJD

Question 4

Is it common?

Answer 4

Yes, there are 800,000 people living with dementia in the Uk

Question 5

Who is affected?

Answer 5

6% aged 70-74 years old, 20% of aged 85-89 years old

Alzheimer’s is more common in women and Vascular/Lewy is more common in Men

Question 6

Risk Factors (8)

Answer 6

1st degree relative, Down’s Syndrome, Homozygosity for APOE 4, Vascular risk factors, reduced physical cognitive activity, depression, loneliness, alcoholism

Question 7

Symptoms & Signs (9)

Answer 7

Memory loss, spacial awareness loss, lack of verbal ability and executive function, irritability, mood disturbance, behavioural change, hallucinations, Agnosia (can’t recognise self in mirror), sedentary

Question 8

Investigations (9)

Answer 8

Physical and mental state examination, Specific memory screening questionnaires, e.g AMTS, Bloods: FBC, U&E, ESR, CRP, Ca, LFT, TFT, B12/Folate; CT, MRI, EEG, LP, Functional imaging

Question 9

Drug Treatment (4)

Answer 9

Acetylcholinesterase Inhibitors e.g Donepezil, N Methyl D Aspartate Antagonists, SSRIs to treat depression, Lorazopam for challenging behaviour

Question 10

Other treatment (9)

Answer 10

Refer to specialist memory service, early discussions to take place e.g advanced directive, Support groups, cognitive stimulation, Physical, Psychological, social and spiritual support

Question 11

Is there a good prognosis?

Answer 11

The outlook for most types of dementia is poor as there is no cure. They tend to continually worsen over time. Condition generally worsens until the patients eventual death