Dementia and Delerium

Question 1

what is Dementia?

Answer 1

Dementia is an irreversible progressive decline of higher cortical function memory, intellect and personality WITHOUT impairment of consciousness.

Question 2

Causes of Dementia

Answer 2

1. Alzeheimer’s
2. Lewy body
3. Vascular
4. fronto-temporal
5. Other: CJD, Picks disease,
6. Pseudo dementia
7. ADC (aids dementia complex)

Question 3

assessment tools for the non-specialist setting?

Answer 3

10-point cognitive screener (10-CS)

6-Item cognitive impairment test (6CIT)

Question 4

Alzheimer’s disease

Prevelance, Age onset, pathophysiology

Answer 4

• 50%
• after 65 yrs of age
• Degeneration of cholinergic neurons in the nucleus basalis of Menyert leading to a deficiency of Ach

Question 5

Alzheimer’s disease

• Risk factors
• Pathological changes
• Diagnostic criteria
• Mx

Answer 5

RFx

Down’s syndrome

Pathological changes

• macroscopic:* cerebral atrophy, Wide Sulci, Large Ventricles
• microscopic*: Deposition of Amyloid plaques and neurofibrillary tangles (tau protein)

Diagnostic criteria

Mx​

Non-pharmacological management:

1. offer “wellbeing activities” to the ptx preference
2. offer group cognitive stimulation therapy

pharmacological management:

1. 1st line: Acetylcholinesterase inhibitors
2. 2nd line: Memantine

Question 6

Lewy body dementia

Prevelance, Age onset, pathophysiology

Answer 6

FLUNTUATING cognitive decline in 20% of cases

Abnormal deposits of a-synuclein (lewy bodies) in brain

Question 7

Lewy body dementia

• Risk factors
• features (3)
• Diagnostic criteria
• Mx

What should be AVOIDED in LEWY BODY DEMENTIA?

Answer 7

RFx

Features

• VIVID VISUAL hallucinations
• Progressive cognitive impairment
• parkinsonism

Diagnostic criteria

• clinical
• (SPECT) also known as DaTscan

Mx​

Non-pharmacological management:

pharmacological management:

1st line: Acetylcholinesterase inhibitors & Memantine

neuroleptics should be avoided ptx r extremely sensitive and may develop “irreversible parkinsonism”