Dementia

Question 1

Dementia definition

Answer 1

An acquired, persistent and generalised disturbance of higher mental functions in an otherwise fully alert person

Question 2

Primary dementias

Answer 2

Alzheimers
Lewy body dementia
Pick’s disease
Huntingtons

Question 3

Secondary dementias

Answer 3

vascular dementias
infection (HIV, syphilis)
Trauma
metabolic
drugs, toxins etc

Question 4

Dementias in order of prevalence

Answer 4

alzheimers
vascular
Lewy body
frontotemporal

Question 5

Diagnosis of dementia

Answer 5

History - collateral, ask about non cognitive symptoms eg agitation, aggression or apathy
cognitive testing- amt, mental state examination

Question 6

Investigations

Answer 6

look for reversible /organic causes- high TSH, low B12, low folate, low thiamine.
MRI- vascular damage or structural pathology
consider EEG if suspected delirium, frontotemporal dementia, CJD or a seizure disorder

Question 7

Vascular dementia

Answer 7

25%. Cumulative effect of small strokes

Question 8

What is characteristic of vasular dementia

Answer 8

sudden onset and stepwise progression

Question 9

What meds should you not use in vascular dementia patients

Answer 9

acetylcholinesterase inhibitors or memantine

Question 10

Lewy body dementia

Answer 10

fluctuating cognitive impairment, detailed visual hallucinations, later parkinsonism, fluctuating levels of attention/ cognition- fluctuates on a daily basis

Question 11

What is Lewy body dementia characterised by histologically

Answer 11

Lewy bodies in brainstem and neocortex

Question 12

what meds should you avoid in lewy body dementia

Answer 12

antipsychotics- increase risk of SE

Question 13

frontotemporal dementia

Answer 13

frontal and temporal atrophy with loss of >70% spindle neurones. progressive, 50-60yrs
rapidly progressive- mean length of illness 7yrs

Question 14

symptoms of frontotemporal dementia

Answer 14

behavioural/personality change, disinhibition, hyperorality, stereotypes behaviour and emotional unconcern

Question 15

what is preserved in frontotemporal dementia

Answer 15

episodic memory and spacial orientation are preserved until later stages

Question 16

what is picks disease

Answer 16

frontotemporal patients who have pick bodies on histology

Question 17

possible causes of dementia

Answer 17

alcohol, repeated head trauma, pellagra, whipples disease, huntingtons, CJD, Parkinson’s, familial AD Alzheimers

Question 18

Alzheimers- symptoms

Answer 18

persistent, progressive, global cognitive decline: visuospatial skill, memory, verbal abilities and executive function (planning) are all affected. also anosognosia lack of insight into the problems engendered by the disease.

Question 19

later symptoms of alzheimers

Answer 19

irritability, behavioural change, mood disturbance, psychosis, agnosia (can’t recognise self in mirror),

Question 20

cause of Alzheimers

Answer 20

environmental and genetic factors both play a role
Cortical atrophy- widening of sulk, narrowing of gyrus
extensive neuronal loss, astrocyte proliferation, gloss
neurofibrillary tangles
neuritic plaques (AB amyloid plaques)

Question 21

neuronal loss in alzheimers

Answer 21

selective- hippocampus, amygdala, temporal neocortex, subcortical nuclei are most vulnerable
95% patients show evidence of vascular dementia

Question 22

gene associated with alzheimers

Answer 22

APOE4 - leading genetic cause of AD
APP
Presenilin

Question 23

pharmacological treatment of alzheimers

Answer 23

acetlycholinesterase inhibitors- donepezil, rivastigmine and glantamine
Antiglutaminergic treatment- memantine - recommended for severe disease or where AChE inhibitors are not tolerated
Antipsychotics- consider in severe, non cognitive symptoms