Dementia

Question 1

Frontotemporal dementia

Pathology

Answer 1

Macroscopic changes seen in Pick’s disease include:
- Atrophy of the frontal and temporal lobes

Microscopic changes include:

• Pick bodies - spherical aggregations of tau protein (silver-staining)
• Gliosis
• Neurofibrillary tangles
• Senile plaques

Question 2

Frontotemporal dementia

Clinical Features

Answer 2

• personality change
• impaired social conduct
• disinhibition
• increased appetite
• perseveration behaviours

Question 3

Alzheimer’s disease (AD

what is it?

Answer 3

is a progressive degenerative disease of the brain accounting for the majority of dementia seen in the UK

Question 4

Alzheimer’s disease (AD

Risk factors

Answer 4

Down’s Syndrome

Question 5

Alzheimer’s disease (AD

Pathology

Macroscopic
Microscopic
Biochemical

Answer 5

Macroscopic:
- widespread cerebral atrophy, particularly involving the cortex and hippocampus

Microscopic:

• cortical plaques due to deposition of type A-Beta-amyloid protein
• intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
• Hyperphosphorylation of the tau protein has been linked to AD

Biochemical:
- deficit of acetylcholine from damage to an ascending forebrain projection

Question 6

Alzheimer’s disease (AD

Medical Management

Answer 6

First line: Anticholinergics = donepezil (contraindicated in bradycardia), galantamine and rivastigmine

Second line: Memantine (an NMDA receptor antagonist)
(if first lines don’t work, if intolerant in anticholinergics, or severe disease)

Question 7

Alzheimer’s disease (AD

Managing other symptoms

Answer 7

NICE does not recommend antidepressants for mild to moderate depression in patients with dementia

Antipsychotics should only be used for patients at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress