Dementia, Delerium, Mild Cognitive Impairment

Question 1

Name the 5 main types of dementia

Answer 1

Alzheimer's
Vascular
Mixed (alz + vasc)
Lewy-Body
Fronto-Temporal

Question 2

Describe the pathophysiology of Alzheimer’s disease

Answer 2

Neurodegeneration leading to cortical atrophy, widening of sulci and ventricular enlargement, due to:

• Tangles of tau
• Beta-Amyloid plaques

Question 3

Describe pathophysiology of Vascular dementia

Answer 3

Small vessel disease in the brain or multiple small infarcts leads to ischaemic damage to brain tissue. This is due to atherosclerosis in cerebral arteries.

Question 4

Describe pathophysiology of Lewy-Body dementia

Answer 4

Aggregation of alpha-synuclein to Lewy Bodies. Causes LewyBody complexes to build up throughout the cortex leading to neuronal loss.

Question 5

Compare the progression of symptoms between, Alzheimers, Vascular and Lewy Body dementia

Answer 5

Alzheimers and Lewy Body are slow and insidious. Vascular is step wise decline.

Question 6

List the two main early symptoms of Alzheimer’s disease

Answer 6

Short term memory deficits (conversations, activities)

Word finding difficulties (place names, objects)

Question 7

List 3 mid stage symptoms of Alzheimer’s disease

Answer 7

Difficulty remembering people names or recognising family/friends
Confusion/disorientation
Repetition
Delusions

Question 8

List 3 late stage Alzheimer’s dementia symptoms

Answer 8

Behaviour and psychological symptoms (aggression, anxiety, agitation)
Urinary or bowel incontinence
Difficulty with activities of daily living
Difficulty eating with knife and fork, and swallowing
Communication difficulties

Question 9

What is early onset Alzheimer’s dementia?

Answer 9

Alzheimer’s disease before the age of 65

Question 10

What type of scans are available to help diagnose dementia?

Answer 10

SPECT scan

DATscan - Lewy Body dementia

Question 11

List 4 potentially reversible causes of dementia

Answer 11

Drugs and alcohol
Space occupying lesions (hydrocephalus)
Hypothyroidism
B-12/folate deficiency

Always check for these!

Question 12

ICD-10 criteria for delirium

Answer 12

Organic cerebral syndrome of non-specific cause, characterised by:

• reduced consciousness or attention
• hallucinations
• memory loss
• behaviour or emotionally disregulation
• sleep wake cycle changes

Question 13

Describe the pathophysiology of delerium

Answer 13

• Increased blood brain barrier permeability
• reduced acetylcholine transmission
• Reduced dopamine transmission

Question 14

Name the three types of delirium

Answer 14

Hyperactive
Hypoactive
Mixed

Question 15

Symptoms of Hyperactive delerium

Answer 15

Confusion, increased arousal, restlessness, agitiation

Paranoid delusions are common

Question 16

Symptoms of Hypoactive delirium

Answer 16

Lethargy, poor eating, reduced motor activity, incoherent speech, lack of interest
(Often mis-diagnosed as depression)