Dementia (Epidemiology, Risk Factors, Investigations)

Question 1

Defintion

Answer 1

Major neurological disorder = progressive decline in cognitive function which impairs daily activity and independence
- affecting multiple domains including language, executive function, memory and social cognition

Question 2

Neurodegenerative types of dementia

Answer 2

Alzheimer’s disease
Lewy body dementia
Frontotemporal dementia
Huntingtons disease
Parkinson’s disease

Question 3

Cerebrovascular types of dementia

Answer 3

Vascular dementia

Question 4

Reversible causes of dementia

Answer 4

Normal pressure hydrocephalus
Vitamin B12 deficiency
Subdural haemorrhage
Wernickes encephalopathy
Hypothyroidism
Intracranial tumours
Hypoglycaemia

Question 5

Epidemiology

Answer 5

Increasing age

Question 6

Risk factor

Answer 6

Age
Family history
Gender = female
Cognitive reserve
- social isolation
- left education early
- low job complexity
Hearing loss

Question 7

DSM-V criteria

Answer 7

Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains:
- Learning and memory
- Language
- Executive function
- Complex attention
- Perceptual - motor
- Social cognition
The cognitive deficits interfere with independence in everyday activities, e.g. paying bills or managing medications
The cognitive deficits do not occur exclusively in the context of delirium
The cognitive deficits are not better explained by another mental disorder, e.g. major depressive disorder, schizophrenia

Question 8

What other diagnostic criteria could be used?

Answer 8

ICD-10

Question 9

Investigations

Answer 9

Clinical diagnosis:
1. Observing a change in behaviour over a period of time
- history and collateral
- use a validated cognitive assessment tool
2. Excluding reversible causes of cognitive decline
- Medication review: anticholinergics, opioids, benzos
- Bloods: FBC, U+E’s, LFTs, glucose, calcium, TFT, B12, folate
- CT/MRI = CORTICAL ATROPHY

Question 10

Name a validated cognitive assessment tool

Answer 10

Mini-mental state (MMSE)
- 11 questions testing orientation, attention, memory, language and visual-spatial skills
Low risk > 25
Mild cognitive impairment: 20-24
Moderate: 13-20
Severe < 12

Question 11

Conservative Management

Answer 11

• Access to memory service: MDT (e.g., specialist dementia nurses, psychologists, and occupational therapists) which is involved in diagnosing and supporting patients
• Education: education about dementia, building personal skills, understanding and responding to behavioural changes, communication skills, looking after well-being, advice and planning for the future
• Advanced care plan: power of attorney, advanced statement on patient’s wishes, preferences to place of care and place of death
• Cognitive stimulation therapy: activities and discussions aimed at improving cognitive and social functioning
• Group reminiscence therapy: uses objects from daily life to stimulate memory and enable people to value their experiences
• Medication review

Question 12

Complications

Answer 12

Disability, dependency and morbidity: inability to carry out activities of daily living (ADLs), complex behavioural care needs, mobility issues leading to falls and fractures, social isolation
Behavioural and psychological symptoms of dementia (BPSD)
Abuse: these individuals are vulnerable and susceptible to abuse
Infection: increased risk of pneumonia and UTIs
Weight loss and malnutrition