Dementia: Clinical Aspects

Question 1

3 Diagnostic criteria for dementia + how long do symptoms have to be present for

Answer 1

Decline in verbal + non verbal memory, esp learning new info
Decline in emotional control OR a change in social behaviour (lability, irritability, motivation, apathy)
Awareness of environment preserved(i.e. not delirium)
Symptoms present for > 6 months

Question 2

4 things which mimic dementia but is not?
DITN

Answer 2

Depression (‘depressive pseudodementia’) - depressed elderly don’t score well in cognitive tests
Intracranial space-occupying lesions (e.g. tumour; subdural haematoma, rare)
Temporal lobe seizures (‘transient epileptic amnesia’, but these resolve)
Normal ageing (‘benign senescent forgetfulness’)

Question 3

Explain 4 ways how normal ageing contributes to cognitive decline

Answer 3

Some cerebral volume loss esp prefrontal cortex & striatum, occipital lobe is last affected!
Decrease in dendritic synapses or loss in synaptic plasticity
White matter decline, e.g myelin sheath deteriorates after ~40 years old
Brain atrophy, but LESS so of the hippocampus

Question 4

3 things u would you see in an ACE III cognitive assessment, + a CT in an alzheimer’s clinical presentation?

Answer 4

ACE-III:
Some attention & naming impairment
Impaired memory (normal registration - but poor delayed recall)
However, Language + visuospatial reasonably intact

MRI / CT head- hippocampal atrophy

Question 5

4 Non cognitive features of Dementia? DPAP
Despite this what shouldn’t be prescribed for dementia patients?

Answer 5

Depression, anxiety.
Psychosis (persecutory delusions, partition delusions), hallucinations.
Agitation, wandering, aggression, etc
Personality change; apathy, disinhibition.

Antipsychotics shouldn’t be prescribed bc it increases risk of stroke, unless they have psychosis

Question 6

9 Risk factors of AD?

Answer 6

Question 7

Outline the main different drug treatments for AD, giving their specific names

Answer 7

Cholinesterase Inhibitors (low ACh in AD):
Donepezil – Once Daily tablet
Rivastigmine patch- need to change it twice daily

NMDA receptor antagonist:
Memantine- dementia pts get agitated by stimulation around them, this dampens that.

Question 8

What is lecanemab?
mechanism, when used + effect, 3 potential adverse events?

Answer 8

IgG1 monoclonal antibody, bindsto Aβ soluble protofibrils, hence reducing Amyloid markers
Used in early AD or Mild Cognitive Impairment -> leads to moderately improved cognition + function
Adverse events: infusion related reactions, oedema, stroke risk

Question 9

If a 50 year old came into clinic with dementia symptoms, what would be the likley diagnosis?
what distinguishes FT vs Alzheimers Disease?

Answer 9

Frontotemporal- this is more likley in younger patients under 65
In FTD: relative intactness of episodic memory
In AD: early episodic memory disturbance
These differences= good diagnostic marker

Question 10

Compare the 2 clinical feature subtypes for frontotemporal dementia
2 language subtypes vs 3 behavioural variants

Answer 10

2 Language Subtypes:
-Semantic memory affected= struggle knowing everyday objects + so having trouble communicating
-Progressive non-fluent aphasia= words missing from sentence

3 Behavioural variants:
-Altered personality + social conduct, e.g making impulsive/sexual comments
-Disinhibition or apathy (related to serotonin levels?)
-Perseveration + utilisation behaviour, eg eating + toilet habits

Question 11

What are the patchy deficits associated w vascular dementia?
3 features + overall description

AlFpNtc

Answer 11

Attention + Language impairment - (serial 7s & word finding)
“frontal pattern” for episodic memory
Night time confusion (common in AD)

Patchy deficits= you dont lose all function at once, eg you can tell good stories but forget where bathroom is

Question 12

What characteristics are more associated w vascular dementia?
DRFANS
name of chart used to assess this?

Answer 12

Question 13

6 clinical features of LBD (aside from dementia ofc)

Answer 13

In LBD= fluctuating cognitive performance & level of performance!!!

Question 14

LBD – Drug management?
what drugs should u avoid?

Answer 14

Cholinesterase Inhibitors
Rivastigmine – patch or BD tablets
NMDA receptor antagonist
Memantine

Avoid antipsychotics like quetiapine, clozapine

Question 15

what does alcohol related brain injury cause?
compare wernicke VS korsakoff + how alcohol is involved in this

Answer 15

Alcohol related brain injury causes frontal atrophy
Vascular causes, head injury, poor diet

Wernicke’s - acute syndrome = impaired conciousness, ataxia, opthalmoplegia - Due to dietary thiamine deficiency

Korsakov’s: profound amnesia for new learning, but good attention/working memory. Confabulation.

Question 16

How do you treat and prevent wernicke-korsakoff syndrome?

Answer 16

Cognition improves when u stop drinking
Give drinkers pabrinex to prevent Wernicke’s encephalopathy, this might prevent Korsakov’s
- however! - Unfortunately, Korsakov’s is irreversible upon alc cessation

Question 17

Describe the natural history of Alzheimers

Answer 17

• Alzheimer’s symptoms are typically present for 1-3 years prior to referral to a memory clinic
• the total duration of illness is between 10 and 12 years,
• mini mental state examination score (MMSE) is usually between 10 and 26 to begin with, and decreased by approximately 3 points per year (though this is very variable)

Question 18

What are the 7 A’s of Alzheimers

Answer 18

1. Anosognosia (don’t know you have memory problems)
2. Agnosia (can’t recognise things, senses are impaired)
3. Apraxia (can’t carry out movements)
4. Aphasia (can’t use language)
5. Altered perception (misinterpret info your brain gives you)
6. Amnesia (memory loss)
7. Apathy (loss of initiative and drive)