Dementia

Question 1

What are irreversible causes of dementia?

Answer 1

1. Alzheimer’s
2. Diffuse vascular disease
3. Lewy-body dementia
4. Fronto-temporal
5. Mixed

Question 2

What are reversible causes of dementia?

Answer 2

1. Subdural haematoma
2. Hydrocephalus
3. Hypothyroidism

Question 3

What is required for a diagnosis of dementia?

Answer 3

Impairment in at least two cognitive domains leading to significant functional decline that can’t be explained by another disorder or adverse effects of medication, these domains can be:
•	Memory
•	Language
•	Behaviour
•	Visuospatial
•	Executive function

Question 4

Using the MSE, what are the symptoms of dementia?

Answer 4

1. Behaviour: restless, repetitive and purposeless activity, rigid, fixed routines
2. Personality changes: sexual disinhibition, social gaffes*, shoplifting, blunting
3. Speech: syntax errors, dysphasia, mutism
4. Thinking: slow, muddled, poor memory (w confabulations), no insight
5. Perception: illusions, hallucinations
6. Mood: irritable, depressed, labile mood and crying

Question 5

What are the Ix of dementia? explain the rationale behind them

Answer 5

1. FBC, B12, folate (increased MCV suggests alcoholism or reduced B12/folate)
   U&E, LFT, gamma GT
2. Ca - renal/hepatic failure, alcoholism, malignancy
3. TSH - hypothyroidism
4. Serology: syphilis, HIV
5. CT/MRI - excludes tumours, hydrocephalus, subdural, stroke

Question 6

What is the general management in regards to law w the patient?

Answer 6

Advance statements - what they wish to be done if they lose capacity
Advance decisions - refusing rx in future
Lasting power of attorney

Question 7

Explain the poss. pharmacological rx of dementia

Answer 7

Acetylcholinesterase inhibitors (rivastigmine, donepezil, galantamine) for MILD-MOD ALZHEIMERS
Memantine for mod Alzheimers if AChEi CI
or for SEVERE alzheimers

Question 8

How do Acetylcholinesterase inhibitors work?

Answer 8

by inhibiting the enzyme that causes the breakdown of acetylcholine (activates muscles, supports cognitive functions)

Question 9

What is the mean survival of Alzheimers?

Answer 9

7 yrs from diagnosis

Question 10

How do people usually die from Alzheimers?

Answer 10

bronchopneumonia

Question 11

What is the pathophysiology of Alzheimers?

Answer 11

amyloid plaques build up in the brain causing reduction in cholinergic transmission and later reduction in synthesis of acetylcholine

Question 12

What are the 4 A’s of amnesia?

Answer 12

agnosia - inability to process sensory info
amnesia
aphasia - inability to speak
apraxia - inability too perform learned movements

Question 13

What is the pathophysiology behind vascular dementia?

Answer 13

result of many small infarcts

Question 14

What is the typical course of vascular d?

Answer 14

stepwise progression w drops in function

Question 15

What is the management of vascular d?

Answer 15

• Aspirin/warfarin therapy
• Control BP
• Anticholinesterases

Question 16

What is the pathophysiology of DLB

Answer 16

⇒ Presence of cortical and subcortical Lewy bodies

Question 17

How does DLB typically present?

Answer 17

repeated falls
transient Loc
parkinsonian features
autonomic dysfunction

Question 18

What occurs in autonomic dysfunction

Answer 18

impaired swallowing
incontinence and constipation
postural hypotension

Question 19

When does memory impairment usually occur in DLB?

Answer 19

LATER

Question 20

What drug can help treat DLB

Answer 20

rivastigmine

Question 21

What is the pathophysiology of frontotemporal dementia?

Answer 21

progressive degeneration of the frontal +/- temporal loves

Question 22

What is the typical course FTD?

Answer 22

insidious personality change and behavioural disturbance

Question 23

When does FTD typically present?

Answer 23

middle age

Question 24

What is early onset dementia?

Answer 24

dementia under 65 yrs