Dementia and Delirium: Clinical and Population Aspects

Question 1

What is the current clinical definition of dementia?

Answer 1

Deficit in >=2 cognitive domains

Sufficient to impact activities of daily living

Question 2

What are the problems with the current clinical definition of dementia?

Answer 2

Cognitive domains subjective and ambiguous - not completely distinct
Activities of daily living subjective and vary between individuals

Question 3

How does the incidence of dementia change after 65yrs old?

Answer 3

Doubles every 5yrs - exponential increase

Question 4

How is the number of dementia sufferers in the population changing?

Answer 4

Increasing

Question 5

How is the prevalence of dementia in the population changing and why?

Answer 5

Decreasing

As population size increasing - smaller proportion with dementia

Question 6

What is the different between CFAS I and II?

Answer 6

CFAS II later but in same geographical region

Question 7

What are CFAS I and II?

Answer 7

Population studies of dementia prevalence

Computerised assessment of whether criteria met in individual

Question 8

What did a 2013 comparison of CFAS I and II find?

Answer 8

Decreased dementia prevalence of multiple old age groups in CFAS II

Question 9

Which factors are thought to be key in explaining the result of the 2013 comparison of CFAS I and II?

Answer 9

Education

CV disease prevention and treatment

Question 10

What are the 3 symptom stages of AD?

Answer 10

Mild episodic memory deficits
Moderate deficits in multiple domains
Global cognitive and functional impairment

Question 11

Which staging system does tau pathology follow and what are the stages?

Answer 11

Braak stages

Entorhinal cortex -> hippocampus -> neocortex

Question 12

Name the 4 main types of dementia

Answer 12

AD
Vascular
Lewy body
Frontotemporal

Question 13

When does vascular dementia occur?

Answer 13

Post-stroke

Question 14

What are the symptoms of vascular dementia?

Answer 14

Variable - depends on brain region affected

Prominent gait issues common

Question 15

What is the pattern of the time-course of decline in vascular dementia?

Answer 15

In steps

Question 16

What is the neuropathology of vascular dementia?

Answer 16

Lacunar infarcts

White matter damage

Question 17

What are the symptoms of Lewy body dementia?

Answer 17

Attention and visuospatial disturbances
Fluctuations in consciousness
REM disorders
Hallucinations

Question 18

What is the neuropathology of Lewy body dementia?

Answer 18

Alpha-synuclein and ubiquitin inclusions (Lewy bodies) - spread from SN to neocortex

Question 19

What are the methodological challenges in dementia epidemiology?

Answer 19

Case ascertainment - dementia definition
Sample selection
Clinico-pathological correlations
Population neuropathology

Question 20

How does stroke recurrence rate vary between a specialist clinic and the general population and what is the implication of this?

Answer 20

Higher in general population

Using secondary care for figures gives underestimate - those who did not survive to secondary care not included

Question 21

How does the rate for MCI progression to dementia vary between the clinic and general population and what is the implication of this?

Answer 21

Higher in clinic

Using clinical sampling gives overestimate - clinic takes more severe cases

Question 22

What is the overall problem with clinical sampling?

Answer 22

Underestimates rates of acute conditions

Overestimates rates of chronic conditions

Question 23

What are the symptoms of delirium?

Answer 23

Disturbance of consciousness

Change in cognition

Question 24

Is delirium acute or chronic?

Answer 24

Acute

Question 25

What causes delirium?

Answer 25

Physiological precipitant and stress conditions - causes cognitive decompensation - causes temporary confusion

Question 26

How does dementia affect the risk of delirium?

Answer 26

Increases

Question 27

How does delirium affect the risk of dementia?

Answer 27

Increases

Question 28

What did a long-term review of hospital cohorts with delirium find and what is a limitation of this study?

Answer 28

Delirium associated with 2x death risk, 13x dementia risk

Not all with delirium admitted to hospital - inaccurate figures - selection bias

Question 29

How do the cognitive trajectories of AD patients vary with and without delirium?

Answer 29

With delirium - greater acceleration in cognitive decline after delirium episode
Without delirium - increased rate of cognitive decline over disease course - but slower than delirium-affected

Question 30

What could the implication of the differing cognitive trajectories between AD patients with and without delirium be?

Answer 30

Delirium could accelerate effects on tau and AB pathology on cognition in AD patients