Dementia

Question 1

What is dementia

Answer 1

Progressive and irreversible loss of higher mental function

Question 2

What is the criteria for a diagnosis of dementia

Answer 2

• memory impairment
• 1 of the following ( aphasia, apraxia, agnosia, disturbance in executive function
• interferes with work/ social life
• not exclusively during delirium
• no better diagnosis

Question 3

What other conditions must dementia be differentially diagnosed from

Answer 3

Delirium
Depression
Drug induced
Mild/ moderate retardation

Question 4

What is involved in the mini mental state exam

Answer 4

Questions related to 
- orientation (eg what day is it)
- Registration (name 3 objects)
- attention and calculation (count down from 100 in 7’s)
- recall
-Language
- repetition 
- complex command 
Maximum of 30 marks 
Below 24 suggests dementia

Question 5

Name some causes of dementia

Answer 5

• Alzheimer’s (54%)
• vascular dementia (16%) not enough blood to the brain
• Lewy body dementia ( associated with Parkinson’s)
• fronto temporal lobar degeneration
• Huntington’s / CJD

Question 6

What conditions could make the dementia temporary

Answer 6

• Brain tumours
• hydrocephalus
• hypothyroidism
• vitamin deficiency

Question 7

What forms of memory problems are there in dementia

Answer 7

• anterograde memory loss

- semantic memory disturbances

Question 8

Describe the stages of dementia

Answer 8

Mild- forgetful, difficulty learning new things
Moderate- progressive memory loss, deterioration evident, lack in personal hygiene, denial, needs care
Moderate/ severe - loss of grooming, wandering, danger to self/ others
Late- doesn’t recognise self/ family, non verbal, forgets how to eat

Question 9

Describe how plaques form

Answer 9

Amyloid precursor proteins are broken down by an enzyme to form beta amyloid. These beta amyloid stick together to form plaques

Question 10

Where in the brain degenerates early in an Alzheimer’s brain

Answer 10

The hippocampus (important for language and memory)

Question 11

What are the causes of plaques and tangles

Answer 11

• genetics
• mutations in APP
• ApOE4

Question 12

What environment fabrics could increase chances of Alzheimer’s

Answer 12

repeated head trauma
Vascular factors
Cholesterol
Hypertension

Question 13

What is vascular dementia

Answer 13

It is caused by lack of oxygen in blood to the brain
Usually step wise deterioration
Can coexist with other dementia’s
May improve

Question 14

Discuss the occurrence of dementia after stroke

Answer 14

6-32%
Risk factors- age
Left hemisphere aphasia stroke
Premorbid cognitive impairment

Question 15

Discuss picks disease and Dementia

Answer 15

Chronic cortical encephalopathy
Tau inclusions and spongiform changes
Impaired judgment
Memory spared

Question 16

Discuss prion diseases

Answer 16

• acquired
• infectious
• loss of all functions
• fatal after 12 months

Question 17

Discuss some treatments

Answer 17

• target increasing acetylcholine by inhibiting breakdown (tacrine , donepezil)
• block excitotoxicity meaning reducing release of mass amounts of glutamate. Also blocks NDMA receptors ( memantine)
  (NDMA receptors at usually bound to magnesium which stops calcium entering cells- calcium mediates neural damage)
  -Treat sleep (flurazepam)
• anxiety ( lorazepam)