Dementia

Question 1

What is dementia

Answer 1

severe impairment or loss of intellectual capacity and personality integration, due to the loss of or damage to neurones in the brain

In a previously unimpaired individual
Beyond what would be expected form normal aging

Question 2

Set of symptoms of dementia

Answer 2

Memory loss
Difficulties with thinking
Problem-solving
Language

Question 3

DSM-5 criteria of dementia

Answer 3

Evidence of impairment of memory AND at least one of:

Language impairment

Apraxia (motor speech disorder)

Agnosia (inability to interpret sensations)

Impairment of executive function

Impairment of functioning
No other medical or psychiatric explanation
>6 months

Question 4

Types of dementia

Answer 4

Alzheimer’s (62%)
Vascular (17%)
Mixed (10%; alzheimers + vascular)
Lewy body dementia

Rarer:
Creutzfeldt Jakob
Huntington’s disease
Karsakoff’s (associated with high alcohol)
Frontotemporal (early personality and behavior changes)
Parkinsons

Question 5

How does dementia affecting different parts of the brain produce symptoms?

Answer 5

Frontal lobe - personality and decision making ability

Temporal lobe - amygdala, hippocampus (memory, emotion)

Parietal lobe - coordination, speech and language

Occipital lobe - vision

Question 6

Symptoms of Alzheimer’s disease

Answer 6

Forgetting names, people, places
Repetitive
Misplacing items in odd places
Confusion about time of day
Getting lost
Problems with word finding
Mood or behavioral problems

Question 7

Symptoms of vascular dementia

Answer 7

Problems with planning or organising
Making decisions
Problem solving

Difficulty following a series of steps - eg. cooking (limit ADL)

Problems concentrating (including short periods of sudden confusion)

Depression
Emotional lability
Early gait disturbance

Question 8

Symptoms of Lewy body dementia

Answer 8

Visual Hallucinations
Spontaneous parkinsonism

Attention
Mood swings
Deterioration of physical abilities
Recurrent falls
Sleep walking

Question 9

Risk factors for dementia

Answer 9

Smoking (atherosclerosis)
Alcohol (LARGE amounts)
Atherosclerosis
Hypercholesterolaemia
Age (esp Alzheimer's and vascular)
Genetics
Mild cognitive impairment

Question 10

Early phase symptoms of dementia

Answer 10

Difficulty embracing change
Repetition of questions
Occasional confusion
Short-term memory loss (loosing items etc)

Question 11

Middle phase symptoms of dementia

Answer 11

Failure to recognise people
Difficulty with daily tasks
Needs prompting

Disorientatin to time, place and person.
Increasingly frustrated.

Question 12

Late phase symptoms of dementia

Answer 12

Weight loss
Incontinence
Aggression
Dysphagia

Decline in speech and understading with no recognition

Question 13

1st line drugs in alzheimer’s disease

Answer 13

Cholinesterase inhibitors: donepezil, rivastigmine, galantamine

Question 14

2nd line drugs in alzheimer’s disease

Answer 14

NMDA (N-methyl-D-aspartate) receptor antagonists

eg. memantine

Question 15

Differentials for possible dementia

Answer 15

Delirium
Infection
Medication
Hypernatraemia
Intoxication

Question 16

When should patients in hospitals be screened for dementia?

Answer 16

All patients aged >75yrs who are admitted to hospital (unplanned)

Usually AMT, then MOCA

Question 17

What is Mild Cognitive Impairment? (MCI)

Answer 17

Evidence of memory decline on formal memory test (MMSE) withot clinical evidence of features of dementia

10-15% go on to develop dementia

Can also be due to psychiatric or physical problems

Question 18

Diagnostic criteria of Alzheimer’s

Answer 18

Memory deficit in cognitive tests
1 of:
-aphasia
-apraxia
-agnosia
-executive function impairment

No evidence of other causes

Question 19

Diagnostic criteria of frontotemporal Dementia

Answer 19

Insidious onset and gradual progression

Early decline in social interpersonal conduct

Early impairment in regulation of personal conduct

Early emotional blunting

Early loss of insight