Dementia and depression

Question 1

what is the definition of dementia?

Answer 1

an acquired decline in memory and other cognitive functions in an alert person that is sufficient to affect daily life

Question 2

what are the main dementia syndromes?

Answer 2

Alzeheimers 
Vascular dementia 
Dementia with lewy bodies 
Parkinsons dementia 
frontotemporal dementia

Question 3

What lobe controls executive function and how might deficits in executive function manifest in dementia?

Answer 3

frontal lobe - reasoning and complex task

Decreased safety awareness, inability to manage finances, poor decision making, poor planning

Question 4

What lobe controls memory and how might deficits in this manifest in dementia?

Answer 4

Temporal lobe

Repetitive questions and conversation, misplaced belongings, forgetfulness, getting lost

Question 5

what lobe controls visuospatial awareness and how might deficits show in dementia?

Answer 5

parietal lobe

Cant recognise faces, poor fine motor ability

Question 6

what lobes control language and how might deficits manifest?

Answer 6

frontal and temporal lobe

Difficulty in thinking of normal words in conversation, hesitation and speech, spelling and writing errors

Question 7

How is dementia diagnosed?

Answer 7

collateral Hx

Congitive exam - MMSE, addenbrookes, MOCA

Cranial nerve and motor exam - abnormal in VD

Psych assessment - depression can mimic

FBC, CRP, ESR, U&E’s, LFT, glucose
- ?underlying cause

Neuroimaging

Question 8

What are the features of AD?

Answer 8

slow progression
Profound short term memory loss
Progression to global cognitive decline
Behavioural change and functional impairement

Question 9

what is the pathophysiology of AD?

Answer 9

Beta amyloid deposited as amyloid plaques and abnormal aggregation of tau protein into neurofibillary tangles. cortical atrophy

Question 10

what treatment options are available for AD?

Answer 10

Acetlycholinesterase inhibitors e.g doneprizil, galantamine and rivastigmine

NDMA receptor antagonist e.g memantine

Antidepressants and antipsychotics

Question 11

What are the features of VD?

Answer 11

patchy cognitive impairment
problem solving difficulty
disinhibition, poor attention and memory
Focal neuro signs e.g hemiparesis, dysarthria and dysphagia
urinary incontinence and falls early

Question 12

what can a physical exam show in VD?

Answer 12

focal neurology consistent with stroke or CVD i.e hyperreflexia, extensor plantars, abnormal gait

Question 13

what may neuroimaging show in VD?

Answer 13

large vessel infarcts
single cortical infarct
microvascular disease

Question 14

what treatements may be of use in VD?

Answer 14

anti-atherosclerosis meds e.g antiplatelet, statin, carotid angioplasty, stenting

BP control

Question 15

what are the features of dementia with lewy bodies?

Answer 15

progressive dementia 
short term fluctuations in cognitive function 
Auditory and visual hallucinations 
mild parkinsonism 
REM sleep behaviour disorder

Question 16

what may physical exam show in lewy body dementia?

Answer 16

Parkinsons signs
OH
autonomic dysfunction

Question 17

what are the treatment options for LBD?

Answer 17

Benzos for behavioural issues
Atypical antipsychotics e.g risperidone
Clonazepam or melatonin for REM sleep behavioural disorder

Question 18

why are atypical antipsychotics used for LBD instead of typical?

Answer 18

typical antipsychotics e.g haloperidol may worsen confusion and parkinsonism?

Question 19

what are the features of frontotemporal dementia?

Answer 19

early age onset
behavioural and language problems predominate
insight lost early
FHx in 50%
disinhibtion, mental rigidity, inflexibility, impairment of executive function

Question 20

why might MMSE be normal in frontotemporal dementia?

Answer 20

It does not assess frontal lobe dysfunction

Question 21

what might a physical exam show in FTD?

Answer 21

ALS signs i.e progressive asymmetrical weakness of spinal or bulbal muscles and wasting
Parkinsonism signs
MND signs i.e fasiculations, atrophy, hyperreflexia

Glabellar, snout, sucking and grasp reflexes

Incontinence

Question 22

what are management options for FTD?

Answer 22

Benzos
SSRI
Mitrazapine or trazodone for sleep
valproate semisodium - anticonvulsant that treats manias, irritability and agression

Question 23

what are the clinical features of depression?

Answer 23

low mood 
anhedonia 
feelings of guilt, worthlessness, hopeless 
Anorexia and weight loss 
Sleep disturbance 
Behavioural disturbance
congitive impairment 
suicidial ideation or self harm 
physical slowness

Question 24

what investigations are useful in geriatric depression?

Answer 24

Geriatric depression scale

Cornell score for depression in dementia

MMSE - does it improve after treatment?

FBC - anaemia causing lethargy
ESR - malignancy or vasculitis
B12 and folate - deficitency can cause low mood
U&E’s - uraemia and dehydration
TFTs - hypothyroid?
Calcium - hypercalcaemia causes depression

Question 25

what non-drug treatment is available for depression?

Answer 25

Supportive

Psychotherapy - CBT, IPT and PST

ECT

Question 26

what drug therapy is available for depression?

Answer 26

SSRIs - sertraline, citalopram

TCA’s - amitriptyline

Serotonin and noradrenaline reuptake inhibitor - Venlafaxine

Serotonin agonist - Mitrazapine

MOAI’s - moclobemide, selegiline, hydrazine