Dementia ( as a whole )

Question 1

Dementia definition + types

Answer 1

Dementia is thought to affect over 700,000 people in the UK and accounts for a large amount of health and social care spending. The most common cause of dementia in the UK is Alzheimer’s disease followed by vascular and Lewy body dementia.

Question 2

Management in primary care

Answer 2

in primary care
1. a blood screen is usually sent to exclude reversible causes (e.g. Hypothyroidism).

2. NICE recommend the following tests: 
FBC
U&E
LFTs
calcium
glucose
TFTs
vitamin B12 and folate levels. 

3. Patients are now commonly referred on to old-age psychiatrists (sometimes working in ‘memory clinics’).
4. mini mental state exam

Question 3

Management in secondary care

Answer 3

1. in secondary care neuroimaging is performed*
2. Exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus) and help provide information on aetiology to guide prognosis and management

Question 4

Common causes of dementia

Answer 4

Alzheimer’s disease
cerebrovascular disease: multi-infarct dementia (c. 10-20%)
Lewy body dementia (c. 10-20%)

Question 5

rare causes of dementia

Answer 5

• 5% of cases
  1. Huntington’s
  2. CJD
  3. Pick’s disease (atrophy of frontal and temporal lobes)
  4. HIV (50% of AIDS patients)

Question 6

differentials of dementia

Answer 6

1. hypothyroidism,
2. Addison’s
3. B12/folate/thiamine deficiency
4. syphilis
5. brain tumour
6. normal pressure hydrocephalus
7. subdural haematoma
8. depression
9. chronic drug use e.g. Alcohol, barbiturates

Question 7

factors suggesting diagnosis of depression over dementia

Answer 7

1. short history, rapid onset
2. biological symptoms e.g. weight loss, sleep disturbance
3. patient worried about poor memory
   reluctant to take tests, disappointed with results
4. mini-mental test score: variable
   global memory loss (dementia characteristically causes recent memory loss)

Question 8

risk factors of dementia

Answer 8

1. age
2. learning difficulties - 75% of people with down’s syndrome get dementia
3. Genetics - APP/PSEN 1 , PSEN 2, APOE 4 gene
4. CVS disease - smoking/heavy alcohol consumptiom
5. Parkinson’s disease
6. Stroke
7. Depression

Question 9

prognosis of dementia

Answer 9

1. Alzheimer’s disease = 7 - 9 years
2. Vascular dementia < 7 years
3. Dementia with Lewy bodies ( 1 - 2 years )
4. Fronto temporal dementia ( 8 - 11 years )

Question 10

clinical features of dementia

Answer 10

1. Cognitive impairment
   - memory problems
   - receptive/expressive dysphasia
   - disorientation of time and place
2. Behavioral + Psychological symptoms
   - Psychosis + Hallucinations
   - Aggitation
   - Depression + anxiety

Question 11

mild cognitive impairment

Answer 11

1. does not fulfill criteria for dementia

2. activities of daily living may not be affected