Dementia

Question 1

Dementia Symptom Groups

Answer 1

• Cognitive impairment: memory, language, attention, thinking, orientation, problem-solving
• Psychiatric/Behavioural disturbances: changed in personality, emotional control, depression, agitation, hallucinations
• Difficulties with ADL: driving, shopping, eating, dressing

Question 2

Dementia Epidemiology

Answer 2

-Increases with age

Question 3

Dementia Aetiology

Answer 3

• Alzheimer’s (50%)
• Vascular (25%)
• Lewy body (15%)
• Frontotemporal (<5%)
• Mixed
• Parkinson’s
• Other treatable causes (hypothyroidism, space occupying lesion, substance misuse…)

Question 4

Dementia Presentation

Answer 4

• Alzheimer’s insidious onset
• Vascular stepwise increase
• DLB fluctuating consciousness, hallucinations, sleep disorders, falls, Parkinsonism
• Parkinsonian features predate by significant amount of time
• Frontotemporal behavioural changes
• History should go back several months at least

Question 5

Dementia Diagnostic Criteria

Answer 5

There are cognitive or behavioural symptoms which:

• Affect ability to function in normal activities
• Represent decline from previous level
• Cannot be explained by delirium or other disorder
• Have been established in H/E (inc. formal cognitive assessment)
• Involve impairment of at least two of the following: ability to acquire and remember new information, judgement, visuospatial ability, language functions, personality and behaviour

Question 6

Dementia Ix

Answer 6

• Ensure no treatable cause has been missed

- Specialist assessment

Question 7

Dementia Management

Answer 7

• Cognitive stimulation programmes, multi sensory stimulation, music therapy, art therapy
• Community care
• Avoid stress factors
• AChE inhibitors for Alzheimer’s, only started by specialists, can cause cholinergic side effects
• Memantine second line
• MMSE
• Avoid tricyclics and other anticholinergics
• Avoid antipsychotics, increase mortality
• Oral medication if aggressive, benzos, antipsychotics