Dementia

Question 1

What is meant by dementia?

Answer 1

Cognitive decline e.g. memory, thinking, orientation, learning, language, accompanied by deterioration in day to function.

Question 2

State 3 common characteristics of dementia.

Answer 2

Memory deficit - recent events. Language deficit - simplified use of language, less use of abstract terms. Higher motor functions - inability to performs acts despite intact sensory system (dressing, eating). Perceptual deficit (agnosia) - inability to understand significance of sensory stimuli.

Question 3

Give 3 symptoms of dementia.

Answer 3

Hallucinations. Delusions. Depression. Apathy. Behavioural disturbance. Sleeping disturbances.

Question 4

What is meant by a hallucination?

Answer 4

Seeing, hearing or smelling something that is not there.

Question 5

What is a delusion?

Answer 5

False belief - things misplaced are thought stolen.

Question 6

What is the difference between dementia and delirium?

Answer 6

Dementia - chronic brain failure (gradual in onset, months to years). Delirium - acute brain failure (acute in onset, couple of hours to days).

Question 7

Give 2 common causes of delirium.

Answer 7

Acute insult e.g. infection, electrolyte imbalance, change in medication. Psychiatric condition e.g. schizophrenia, major depression.

Question 8

State 3 irreversible causes of dementia.

Answer 8

Alzheimer’s Disease. Vascular Dementia. Fronto-temporal dementia (Pick’s Disease). Parkinson’s Disease Dementia. Lewy-body Dementia. Huntington’s Disease. Creutzfeldt-Jakob Disease.

Question 9

State 2 reversible causes of dementia.

Answer 9

Alcohol dependence. Medical conditions e.g. hypothyroidism, vitamin B12 deficiency, syphilis (treated with penicillin). Normal pressure hydrocephalus (NPH) - venous drainage of CSF (back-up of fluid with the brain).

Question 10

State 2 ways to diagnose dementia.

Answer 10

Vitamin B12 test. TSH level test. Rapid plasma reagin test (RPR) - check for syphilis. MRI - look at ventricles.

Question 11

State a characteristic of Alzheimer’s Disease.

Answer 11

Gradual loss of memory. Cognitive functions decline over-time - language, visuospatial, executive functions.

Question 12

State a causes Vascular dementia.

Answer 12

Manifestations of atherosclerosis e.g. hypertension, diabetes, coronary artery disease.

Question 13

State a characteristic of Vascular dementia.

Answer 13

Gait abnormality. Neurological defect - speech, vision problems.

Question 14

State 2 behavioural changes of Frontotemporal Dementia.

Answer 14

Personality changes. Impaired judgment. Apathy (lack of enthusiasm). Disinhibition (lack of restraint).

Question 15

What is a cause of Frontotemporal Dementia?

Answer 15

Atrophy of frontal + temporal lobes.

Question 16

What’s the difference between Parkinson’s Disease Dementia and Lew-body Dementia?

Answer 16

Parkinson’s Disease - symptoms of Parkinsonism first, dementia later on. Lewy-body dementia - dementia first, parkinsonism later.

Question 17

State 2 characteristics of Lewy-body Dementia.

Answer 17

Recurrent visual hallucinations. Fluctuating episodic deficits of attention and alertness (confused with delirium).

Question 18

State a symptom of Huntington’s Disease.

Answer 18

Chorea - involuntary, purposeless movements. Dementia.

Question 19

What causes Creutzfeldt-Jakob Disease?

Answer 19

Prions - infectious, abnormally folded intracellular proteins.

Question 20

State a symptom of Creutzfeldt-Jakob Disease.

Answer 20

Myoclonus - jerking movement of muscle group

Question 21

What is Chronic Traumatic Encephalopathy?

Answer 21

Dementia following head trauma - veterans/victims of domestic abuse.

Question 22

State a symptom of HIV-Associated Neuro-cognitive Disorder (HAND).

Answer 22

Impaired function. Impaired attention. Changes in personality. Changes in behaviour.

Question 23

State 3 treatments for dementia.

Answer 23

Acetylcholinesterase inhibitors e.g. donepezil, galantamine, rivastigmine. NMDA antagonists e.g. memantine. Medication for symptoms e.g. depression, hallucinations, agitation, sleep disturbance. pharmacological approach - reminiscence therapy.

Question 24

State an acetylcholinesterase inhibitor.

Answer 24

Donepezil. Galantamine. Rivastigmine.

Question 25

State an aim of dementia treatment.

Answer 25

Treat associated disorders e.g. chest infection. Address functional problems e.g. reminders to take medication. Carer support and advice. Manage risk factors e.g. vascular dementia.