Dementia

Question 1

How do you diagnose dementia

Answer 1

Cognitive decline from a previously higher level of functioning with impaired memory and at least one other cognitive domain, from:

• aphasia (language)
• apraxia (purposeful actions)
• agnosia (recognition)
• Executive function (goal-directed planning, decision making)

Question 2

What do you need to rule out in a dementia diagnosis

Answer 2

Other neurological diseases like delirium

Question 3

vascular risk factors for dementia

Answer 3

Atherosclerosis
Diabetes
genetics
Hypertension

Question 4

Degeneritive/inherited risk factors for dementia

Answer 4

Down syndrome

Genetic

Question 5

What is the most common cause of dementia

Answer 5

Alzheimer’s disease

Question 6

What is the presentation of Alzheimer’s

Answer 6

Atrophic brain:

• cerebral cortex
• hippocampus

Question 7

What tangles and plaques are there in Alzheimers

Answer 7

neurofibrillary tangles in neurones (bundles of aggregated and twisted tau protein)

Plaques of amyloid protein between neurones

Question 8

How do plaques and tangles affect brain

Answer 8

Disrupt neurotransmission and cause nerve cell death

Question 9

What does brain of an Alzheimer’s patient look like

Answer 9

Narrowed gyro
Increased Sylvian fissure
Global shrinkage
Widened sulcal margins

Question 10

Subtypes of vascular dementia

Answer 10

Lacunar disease, microangiography

Multi-infarct disease (recurrent strokes)

Diffuse white matter disease

Vascular Parkinsonism (basal ganglia)

Question 11

Risk factors for vascular dementia

Answer 11

Diabetes
Hypertension
Smoking
Other vascular pathology
Previous strokes

Question 12

Presentations of vascular dementia

Answer 12

Patchy cognitive impairment

Frontal lobe, extrapyramidal, pseudobulbar features

Emotional liabiility

Urinary incontinence and falls

Apathy and depression (if predominantly subcortical)

Question 13

Vascular dementia vs Alzheimer’s disease

Answer 13

Onset is gradual in Alzheimers vs sudden is more prevalent in vascular dementia

Abrupt change in cognition in vascular dementia

Motor/sensory deficits, gait disturbance, incontinence, speech deficits in vascular dementia. Normal functioning until late stage and speech deficits in Alzheimer’s

Question 14

What is dementia and Parkinsonism

Answer 14

Dementia with Lewy bodies

Parkinson’s disease with dementia

Question 15

Presentations of dementia with Lewy bodies

Answer 15

Difficulty sleeping, loss of smell and visual hallucinations can precede movement and other problems by as long as 10 years. Can be unrecognised or misdiagnosed until later stages

Question 16

Dementia with Lewy bodies pathology

Answer 16

Lewy bodies are protein aggregates, balloon-like structures that form inside neurones

Neurones in the substantia nigra die or become impaired and cortex degenerates

Question 17

Symptoms of Alzheimer’s like dementia with Lewy bodies

Answer 17

Memory loss,
poor judgment
Confusion

Question 18

Symptoms of Parkinson’s like dementia

Answer 18

Difficulty with movement and posture, shuffling walk

Question 19

Key presentations of Dementia with Lewy bodies

Answer 19

Visual hallucinations (animals, little children, not always distressing)

Fluctuations in attention and alertness

Persecutory delusions and other neuropsychiatric features

Question 20

What are people with Parkinson’s disease at risk of developing

Answer 20

Dementia

Question 21

Which Parkinson-plus syndromes increase risk of dementia

Answer 21

Multiple system atrophy

PSP

CBD

Question 22

What are the triad symptoms of Normal Pressure Hydrocephalus

Answer 22

Gait disturbance
Cognitive Impairment
Urinary incontinence

Question 23

Management of Normal Pressure Hydrocephalus

Answer 23

CT of head
Lumbar puncture

MMSE (or other cognitive test) before and after

Gait assessment before and after you take CSF

Question 24

If removal of fluid for hydrocephalus is successful, what do you do

Answer 24

Refer to neurosurgery for shunt procedure

Question 25

What is alcohol related dementia

Answer 25

Drinking excess alcohol over a long period of time damages brain. Features similar to Alzheimer’s disease

Abstaining from alcohol may allow improvement in symptoms

Question 26

What is Wernicke encephalopathy-Korkasoff syndrome

Answer 26

Alcohol abuse can lead to a deficiency in thiamine or vitamin B1, which is needed to support brain function

The lack of thiamine cause brain damage (alcohol abuse most common cause)

Triggered by abrupt alcohol withdrawal e.g. hospital admission

Question 27

What is the most common cause of lack of thiamine

Answer 27

Alcohol abuse

Question 28

How do you treat Wernicke encephalopathy- Korsakoff syndrome

Answer 28

Accurate alcohol history

Appropriate dose of chlordiazepoxide

Multivitamins: IV Pabrinex or oral multivitamins and thiamine

Question 29

What is Wernicke encephalopathy

Answer 29

Triad of confusion, ataxia and opthalmoplegia

Potentially reversible with treatment

Untreated develops into Korsakoff

Question 30

What is Korsakoff syndrome

Answer 30

Irreversible brain damage

Can follow an episode of Wernicke encephalopathy or can gradually develop

Amnesia and confabulation

Lack of insight and apathy

Question 31

What history do you take with suspected dementia

Answer 31

Take history relevant to risk factors

• alcohol and other drug use
• Family history
• Psychiatric history (depression)

Speed of onset and duration

Collateral history (safety at home- apraxia, executive functioning, DRIVING!

Question 32

Treatment for dementia

Answer 32

Acetylcholinesterase inhibitors

NMDA receptor antagonist

Question 33

Side effects of AChEI

Answer 33

gastrointestinal; nausea, dyspepsia, diarrhoea

Weight loss

Muscle cramps

Bradycardia

Hypotension

Urinary retension