Dementia

Question 1

clinical features of dementia

Answer 1

• loss of recent memory
• impairment of judgement
• alteration in personality and mood
• disorientation in time and space
• language affected (late)

Question 2

common causes of dementia

Answer 2

• Alzheimer’s
• vascular dementia
• DLB

Question 3

Uncommon causes of dementia (briefly describe)

Answer 3

• fronto-temporal dementia (usually <65yrs with disinhibition, STM well preserved)
• dementia associated with Down’s syndrome
• CJD

Question 4

reversible causes of dementia

Answer 4

• neurosyphilis
• B12/Folate deficiency
• cerebral neoplasm
• normal pressure hydrocephalus
• hypothyroidism
• alcohol abuse (W/K syndrome)

Question 5

how does Wernicke’s present

Answer 5

triad of opthalmoplegia, confusion and ataxia

Question 6

investigations if suspect dementia

Answer 6

-FBC
-U&Es
- LFT
TFTs
plasma glucose
vitamin B12 folate
serology for syphilis
brain CT/MRI

Question 7

Pathology of alzheimer’s

Answer 7

neurofibrillary tangles
amyloid plaques
depletion of acetylcholine

Question 8

genetic risk factors for alzheimers

Answer 8

apo E4

Chr 1,14,21

Question 9

treatment of alzheimers

Answer 9

acetylcholinesterase inhibitors- galantamine, donepezil, rivastigmine
SSRIs or memantine for behavioural sx

Question 10

define vascular dementia and its progressio

Answer 10

multiple infarcts caused by embolic or arterial disease often with abrupt onset and stepwise progression

Question 11

management of vascular dementia

Answer 11

manage hypertension, diabetes and cholesterol

- low dose aspirin regime

Question 12

what is DLB and what are the characteristics

Answer 12

widespread presence of lewy bodies in the cerebral cortex
- parkinsonian features (bradykinesa, rigidity)
- visual hallucinations (vivid)
- neuroleptic sensitivity
often present with postural hypotension and falls

Question 13

management of DLB

Answer 13

No specific treatment

anticholinesterases of some benefit

Question 14

what is acute confusional state

Answer 14

abrupt onset of clouding of consciousness, impairment of orientation with clinical picture often fluctuating with lucid intervals

Question 15

causes of delirium

Answer 15

U PINCH ME
urinary retention, pain, intoxication/infection, nutrition/dehydration/, hydration (under)/hypoxia, medication, environmental

Question 16

core features of delirium (4)

Answer 16

1. acute onset or fluctuating course
2. inattention
3. altered consciousess
4. disordered thinking

Question 17

other features of delirium

Answer 17

DELIRIUM
Disordered thinking
euphoria/fearful
Language impairment
Illusions/delusions/hallucinations
reversal of sleep-wake cycle
inattention
Unaware/disorientated
Memory deficit

Question 18

treatment of delirium

Answer 18

identify and remove cause
avoid sedation
short acting hypnotic for agitation/confusion