Dementia

Question 1

Alzheimer’s and life expectancy

Answer 1

Reduced life expectancy
Mean survival is 7 years
Death most commonly from BRONCHOPNEUMONIA

Question 2

Dementia and driving

Answer 2

Assess patient’s ability to drive based on their function

PATIENTS WITH DEMENTIA MUST INFORM THE DVLA

Question 3

What medication is first line for Alzheimer’s?
Give 3 examples
How do they work?

Answer 3

Acetylcholinesterase inhibitors
Donepezil, rivastigmine, galantamine
Increase cholinergic transmission in the brain

Question 4

Side effects of Ach inhibitors

Answer 4

Insomnia, GI upset, anorexia

Some cases: increased confusion and agitation

Question 5

When would you add a second drug for Alzheimers?

What is second line?

Answer 5

If Ach not tolerated or in severe dementia

Memantine (NMDA receptor antagonist)

Question 6

Side effects of memantine

Answer 6

Diarrhoea, insomnia, dizziness, headache, hallucinations

Question 7

What are some of the behavioural BPSDs?

Answer 7

wandering
restlessness
pacing
agitation
aggression
swearing

Question 8

What are some of the psychological BPSDs?

Answer 8

Anxiety and depression
Insomnia
Delusions
Hallucinations

Question 9

Possible causes of worsening BPSDs

Answer 9

PINCH ME!

pain, infection, nutrition, constipation, hydration, medication, environment change

Question 10

How are BPSDs managed?

Answer 10

treat the cause

psycho - aromatherapy, sensory stimulation, environment modification

medication as a LAST RESORT

Question 11

When is medication indicated for BPSDs?

What is the only licenced medication?

Answer 11

LAST RESORT ONLY!
e.g. agitation/ aggression
Risperidone

Question 12

What is Lewy body dementia?

Answer 12

Lewy bodies in the brainstem and cortex

Question 13

Core features of LBD

diagnostic criteria is 2 of these

Answer 13

FLUCTUATIONS in cognitive performance

Features of PARKINSONS

Visual hallucinations

Question 14

Other associations of LBD (other than the core features)

Answer 14

Sleep disturbance
Depression
Transient loss of consciousness

Question 15

What is the difference between dementia in PD and LBD

Answer 15

Dementia in PD: PD symptoms for >1 year before cognitive sx

LBD: cognitive symptoms within one year

Question 16

Why is management of LBD complex?

Answer 16

PD and LBD related to reduced DA

Psychosis = increased DA

BALANCE BETWEEN PD AND PSYCHOTIC SYMPTOMS

Question 17

Which Ach inhibitor can be used for LBD?

Answer 17

Rivastigmine

Question 18

What should be avoided in LBD and why?

Answer 18

Antipsychotics

Worsen symptoms of PD

Question 19

What is fronto-temporal dementia?
How is it diagnosed?
How common is it?

Answer 19

Degeneration of the anterior part of the brain - focal gyral atrophy
MRI for diagnosis!!
AKA Pick’s disease

Rare!

Question 20

What are the 3 core features of fronto-temporal dementia?

Answer 20

Behavioural changes - change in personality/ diet/ emotional blunting

Progressive non-fluent aphasia - loss of language skills

Semantic dementia - loss of knowledge

Question 21

What must be avoided in fronto-temporal dementia?

Answer 21

AVOID ACETYLCHOLINESTERASE INHIBITORS!! (can make behavioural abnormalities worse)

Question 22

What are some rarer causes of dementia?

Answer 22

CJD
Huntington's
HIV
Alcohol and drug abuse
Whipple's disease
Parkinson's