Dementia

Question 1

What is ICD-10 Classification for Dementia?

What’s the prevalence in the 65+ population?

Answer 1

• Memory loss, Cognitive impairment, Awareness of environment is preserved (not delirium), Decline in social behaviour, Symptoms present for >6 months
• 7-10%

Question 2

ALZHEIMER’S DISEASE (50-60%):
What are the symptoms?
→ When do these typically present?

What will a CT/MRI show?

What are its Risk factors?

What is the Pathophysiology of it?

How is it managed? Give examples

Answer 2

• Memory loss, Depression, Anxiety, Psychosis, Hallucinations, Agitation, Wandering, Day-night reversal, Personality change, Apathy
  → 1-3 years prior to referral
• HIPPOCAMPAL ATROPHY
• Elderly, Vascular risk factors (DM, HTN, Smoking), Family history, Hypothyroidism, Head trauma
• • AMYLOID PLAQUES AND NEUROFIBRILLARY TANGLES
  • Primarily cholinergic neuronal cell death
• • Acetylcholinesterase Inhibitors e.g. Donepezil, Rivastigmine
  • NMDA receptor antagonist e.g. Memantine

Question 3

VASCULAR DEMENTIA (15-20%):
When does it occur?

What is it often mixed with?

How does it progress?

What is Large Vessel Disease?

What is Small Vessel Disease?

Answer 3

• Post-stroke
• Alzheimer’s
• Step-wise decline as symptoms stay the same for a while before suddenly getting worse
• Strategic single infarct, Multiple CORTICAL GREY MATTER infarcts
• Multiple LACUNAR WHITE MATTER infarcts, Occlusion of single deep penetrating artery

Question 4

PARKINSON’S DISEASE DEMENTIA (PDD) and DEMENTIA WITH LEWY BODIES (DLB):
PDD:
When is it diagnosed?

DLB (10-15%):
When is it diagnosed?

What are the neuronal changes?
→ Where is it found?
→ What’s it marked by?

What other changes occur?

What are the symptoms?

How is it managed? Give examples
→ What should be avoided? Why?

Answer 4

• If parkinsonian symptoms have developed >12 months prior to dementia

• If both motor AND cognitive symptoms develop <12 months OR cognitive prior to motor
• Neuronal inclusions, abnormally phosphorylated neurofilaments, UBIQUITIN and α-SYNULCEIN
  → Paralimbic, Neocortical areas, Brainstem
  → ↓Ach
• Lewy neurites and Amyloid plaques
• HALLUCINATIONS, PARKINSONISM, FLUCTUATING COGNITION, Dementia, Falls, REM sleep disorder
• • Acetylcholinesterase Inhibitors e.g. Rivastigmine
  • NMDA receptor antagonist e.g. Memantine
  → Antipsychotics as they reduce Dopamine, which is already low in those with Parkinson’s

Question 5

FRONTOTEMPORAL DEMENTIA (PICK'S DISEASE) (4-6%):
When does it typically occur?

What will a CT/MRI show?

What changes occur?

What are the symptoms?

Answer 5

• 45-65yrs
• Atrophy of Frontal and Anterior Temporal lobes
• • Tau inclusions (Pick bodies)
  • Ballooned cells (Pick cells)
• • Semantic and Progressive Non-fluent Aphasia
  • Changes in personality and social conduct, Apathy, Perseveration (repetition of a response/behaviour)
  • Poor verbal fluency

Question 6

ALCHOLISM:
Which part of the brain changes?

What are the 3 symptoms of Wernicke’s Encephalopathy?
→ What is it due to?

What are the symptoms of Korsakov’s Syndrome?

Answer 6

• Frontal lobe
• Acute loss of consciousness, Ataxia, Ophthalmoplegia
  → Thiamine deficiency
• • Profound Amnesia for new learning, but Good attention/working memory
  • Confabulation