Dementia

Question 1

What are the three differentials for cognitive impairment?

Answer 1

• dementia
• delirium
• depression (psuedodementia)

Question 2

What is dementia? (definition) is it progressive? is it irreversable?

Answer 2

• acquired, global impairment of higher cortical functions including memory (both short and long term)
• often progressive although not necessarily irreversable

Question 3

describe 5 clinical features of dementia? is there a clouding of consciousness?

Answer 3

• impaired abstract thinking
• impaired judgement
• other disturbances of higher cortical function (agnosia/visuospatial difficulties)
• change in personality
• memory impairment and intellectual impairment cause significant social and occupational impairments
• NO clouding of consciousness

Question 4

what are the 4 types of dementia?

Answer 4

1- alzheimers disease (65%)
2-vascular dementia (can have mixed vascular and alzheimers)
3- lewy body dementia
4 - frontotemperal dementia AKA pick’s disease

Question 5

Which dementia:

memory problems for a period of a few years and is gradual, initially short term memory loss, insidious onset

Answer 5

Alzheimers disease

Question 6

Which dementia:

steep stepwise decline, physical symptoms such as walking problems/broad based gait

Answer 6

vascular dementia

Question 7

Which dementia:

memory problems, visual hallucinations, parkinsonism, unexplained falls

Answer 7

lewy body dementia

Question 8

Which dementia:

Late 50’s, behavior/personality changes

Answer 8

frontotemporal dementia

Question 9

Where does alzheimers disease begin?

Answer 9

nucleus basilis of meynert (medial part of the temporal lobe)

Question 10

describe 5 clinical features of alzheimers disease?

Answer 10

• word finding and name difficulties
• geographic disorientation
• disinterest in surrounding
• sleep disturbance
• behavioral changes

Question 11

What is the pathophysiology of lewy body dementia?

Answer 11

protein deposits (lewy bodies) are in neurons and this kills them

Question 12

Describe 5 clinical features of lewy body dementia

Answer 12

• fluctuating cognitive ability
• sleep disturbance
• parkinsonism (if pt. has parkinson’s disease >1yr they have parkinson’s dementia NOT LBD)
• unexplained falls
• visual hallucinations

Question 13

What treatment is important NOT to use for lewy body dementia

Answer 13

-antipsychotics (typical) for LBD or parkinson’s

Question 14

What age group does frontotemporal dementia affect?

Answer 14

younger age group than other dementias (50’s)

Question 15

what changes are seen in frontotemporal dementia? what is the nature of the cognitive impairment?

Answer 15

• personality/behavioral changes (not conforming to social norms)
• more subtle cognitive impairment (verbal fluency/proverb difficulty/abstract thought/sequencing)

Question 16

What are some reversable causes of cognitive impairment? (8)

Answer 16

• korsakoff’s syndrome (has some degree of reversability), not progressive if stop alcohol
• delirium
• depressive pseudodementia
• fugue (conversion disorder due to a mental trauma)
• normopressure hydoencephaly
• B12 deficiency
• folate deficiency
• hypothyroid

Question 17

What is normopressure hydroencephaly?

Answer 17

Ataxia
Cognitive impairment
Urinary incontinent
(Walking/Wet/Wacky)
-this is due to slow accumalation of CSF

Question 18

What is the difference between anteretrograde amnesia and retrograde amnesia?

Answer 18

Anteretrograde amnesia: difficulties acquiring new material and remembering of events since onset of illness/injury
Retrograde amnesia: difficulties to remember information prior to illness/injury

Question 19

How to diagnose dementia? (8) what should be used in the diagnosis according to SIGN?

Answer 19

2+ of:

• forgetfulness
• memory loss
• confusion
• poor reasoning and logic
• personality changes
• poor judgement
• ability to focus
• visual perception

If suspected cognitive impairment, MMSE used in diagnosis of dementia
-initial cognitive tests can be improved by use of addenbrooks.

Question 20

What four areas of cognition does MMSE test?

Answer 20

• orientation
• memory
• visuospatial
• language

Question 21

What are the advantages of MMSE? (2)

Answer 21

• quick

- diff. language

Question 22

What are the disadvantages of MMSE? (6)

Answer 22

• not adjusted for age
• poor examination of executive functioning
• poor in severe impairment = floor effect (Q’s too difficult for sample)
• poor in high pre-morbid functioning
• may not indicate problems in early stages
• significant focus on verbal functioning to exclusion of non-verbal skills

Question 23

What 6 areas of cognition does the addenbrooks examination test? how long does this take?

Answer 23

• orientation
• memory
• attention
• exec. function
• language
• visuospatial functioning

15mins - bridges the gap between MMSE and neuropsychological assessments

Question 24

When should neuropsychological assessments be used according to SIGN? where is this undertaken?

Answer 24

• should be used in dementia diagnosis, esp. when not clinically obvious
• undertaken with psychological therapy services

Question 25

What is a neuropsychological assessment used for? (8)

Answer 25

• identify areas of deficits/preserved functioning in cognitive profile
• aids diagnostic process
• obtain baseline assessment of functioning
• provide prognostic information
• inform/facilitate interventions and strategies
• monitor change in cognitive functioning
• evaluate effectiveness of interventions
• provide indicators regarding rate of recovery