Dementia

Question 1

What types of dementia exist?

Answer 1

Alzheimers

Lewy-bodies

Vascular

Fronto-temporal

Rare = CJD

Question 2

What is the most common cause of dementia?

Answer 2

Alzheimers

Question 3

How does dementia present?

Answer 3

Memory deficit = diff with new info, short term memory loss

Behavioural = altered personality

Physical = incontinence, reduced oral intake, diff swallowing

Language = anomic aphasia, diff understanding

Visuospatial = unable to identify visual and spacial relationships between objects

Question 4

How does dementia effect the cortex?

Answer 4

Neuronal degeneration

Question 5

What is an MMSE test?

Answer 5

Mini mental state exam

Gives score out of 24

Mild, moderate, severe impairment

Assess cognitive base

Repeat to monitor progression of decline

Question 6

How can you differentiate between delirium vs dementia?

Answer 6

Confusion assessment method – CAM score

Acute change or fluctuating mental status

Hypoactive or hyperactive

Inattention

Disorganised thinking

Each factor is indicate of delirium

Question 7

How does dementia appear on CT?

Answer 7

Dilation of sulci, atrophy of gyri

Dilation of ventricles

Question 8

Outline the progression of cognitive decline in dementia

Answer 8

Vascular = vascular events cause step by step decline

Alzheimer’s = gradual decline

Lewy body = fluctuating, short periods of improvement

Question 9

Explain the microscopic pathology of Alzheimer’s disease

Answer 9

Amyloid-beta plaques

Neurofibrillary tangles

Question 10

What are the stages of Alzheimer’s disease?

Answer 10

Mild = minor memory loss, diff remembering new info

Moderate (normally preset here) = confusion, diff in self-care, behavioural changes

Severe = completely incapacitated

Question 11

Outline the pathology in lewy body dementia

Answer 11

Lewy bodies in the cortex and substantia nigra = Parkinson’s symptoms

Question 12

How does lewy body placement differ Parkinson’s and dementia?

Answer 12

P = found just in substantia nigra

D = found everywhere including substantia nigra

Question 13

Describe the pathology of vascular dementia

Answer 13

Arteriosclerosis of the blood vessels supplying the brain

Diffuse small vessel disease VS infarcts (large vessel disease)

Results in decreased/cut off blood supply to specific part of brain

Question 14

How is vascular dementia managed?

Answer 14

Assess cardiovascular risk

Treat hypertension and high cholesterol

Question 15

Outline the clinical features of frontotemporal dementias

Answer 15

Onset at a younger age

Alteration of social behaviour and personality: agitation, depression

Impaired judgment and insight – gambling, taking off clothes, inappropriate comments

Speech falls eventually to a state of mutism

Question 16

How can dementia be managed?

Answer 16

Therapies = pets, babies

Social care = risk assessment, care needs, mental capacity act

Drugs = cholinesterase inhibitors, memantine

Memory aids = orientation boards, remembrance therapy, life stories