Dementia

Question 1

What is needed for a diagnosis of dementia?

Answer 1

A decline in memory - most evident in learning new information and verified from history plus a decline in cognitive abilities enough to impact on daily living and functioning. This can be characterised by a deterioration in:

• Judegement
• Thinking
• Planning
• Organising

2. Consciousness is not impacted
3. Decline in emotional control, motivation or social behaviour such as:
   - Emotional lability
   - Irritability
   - Apathy
   - Coarsening of social behaviour
4. Present for at least six months

Question 2

What is mild cognitive impairment?

Answer 2

When there is evidence of early memory decline on formal memory tests (e.g. MMSE) without clinical evidence of the other features of dementia.

Question 3

What is the prevalence of dementia?

Answer 3

7% over 65 and 17% over 80

Question 4

What is the difference between cortical and subcortical dementia?

Answer 4

Cortical- problems with memory, language, thinking and social skills
Subcortical- problems with emotions, movements and memory problems

Question 5

What are degenerative causes of dementia?

Answer 5

Alzheimer’s Disease
Frontotemporal dementia
Lewy Body Dementia
Parkinson’s Disease
Huntington’s disease
Progressive supranuclear palsy

Question 6

What are vascular causes of dementia?

Answer 6

Multi-infarct dementia
Cerebral infarcts
Binswanger’s disease
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)
Vasculitis e.g. lupus

Question 7

What are infectious causes of dementia?

Answer 7

Syphilis
Cryptococcus
Sclerosing panencephalitis (SPE)
Progressive multifocal leukoencephalopathy (PML)
HIV
Creutzfeld-Jakob disease (CJD)

Question 8

What are the toxic, endocrine and metabolic causes of dementia?

Answer 8

Alcohol-related
Heavy metals
Drug intoxication
Hypothyroidism
B12 and folate deficiencies
Paraneoplastic
Inherited metabolic disorders eg Wilson's disease

Question 9

What are the early, middle and late stage symptoms of dementia?

Answer 9

Early- repetition of questions, short term memory loss, difficulty embracing change
Middle- difficulty with daily tasks, needs prompting, failure to recognise people
Late- weight loss, incontinence, aggression, decline in speech

Question 10

What are the genes associated with early onset AD?

Answer 10

Amyloid precursor protein (APP)(chromosome 21)
Presenilin gene 1 (PSEN-1)(chromosome 14)
Presenilin gene 2 (PSEN-2)(chromosome 1)

Question 11

What are the genes associated with late onset AD?

Answer 11

APO-E2 (mildly protective)
APO-E3 (AD by late 80s)
APO-E4- increases risk

Question 12

What are the genes associated with vascular dementia?

Answer 12

Notch3 linked with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)
variation in the APP gene causes heritable cerebral haemorrhage with amyloidosis (HCHWA)

Question 13

What are the risk factors for dementia?

Answer 13

Smoking- vascular
Alcohol- (moderate protective)
Atherosclerosis- vascular/AD
Hypercholesterolaemia- vascular