Dementia - Neurobiology and clinical aspects

Question 1

What is dementia

Answer 1

• Cognitive impairment — progressive; affecting more than one cognitive function; affecting daily living; due to brain disease; occurring in adults

Question 2

How is cognition broken down in brain disease

Answer 2

• Cognition breaks down by domains: memory, language, visuospatial, executive, etc - this is how you investigate it clinically

Question 3

How many new cases of dementia are there each year worldwide

Answer 3

• 7.7 million new cases each year worldwide(WHO)

Question 4

Non-progressive causes of dementia

Answer 4

• Head injury, stroke, meningitis/encephalitis, etc

Question 5

Causes of dementia that appear progressive but are not damaging the brain

Answer 5

• Systemic disease(metabolic, endocrine)
• Prescribed drugs
• Psychiatric illness
• Poor sleep
• Chronic pain
• Thyroid
• Sodium levels

Question 6

Causes of dementia that damage the brain but not neurodegenerative

Answer 6

• Cerebrovascular disease(vascular dementia)
• MS
• Alcohol
• Brain tumours
• Hydrocephalus
• HIV
• B12 deficiency

Question 7

Neurodegenerative diseases contributing to dementia

Answer 7

• Alzheimer’s disease
• Dementia with lewy bodies(closely related to parkinson’s)
• Also fronto-temporal lobar degeneration spectrum
• Huntington’s
• Creutzfeldt-Jackob(prion) disease

Question 8

Is there any treatment for dementia

Answer 8

• Depends on the cause
• Yes for depression, drugs, pain, sleep, tumours, etc
• There is no disease-modifying treatment for neurodegenerative dementias

Question 9

Examples of how dementia symptoms are managed

Answer 9

• Memory aids

- Cholinesterase inhibitors etc

Question 10

How can function be maintained in dementia patients

Answer 10

• Physical and mental activity
• Diet
• Vascular RFs(evidence slim)

Question 11

Examples of complications or exacerbating factors of dementia

Answer 11

• Falls
• Infections
• Malnutrition

Question 12

Groups of drugs that should be avoided in dementia treatment

Answer 12

Avoid:

• Antimuscarinics
• Antipsychotics
• Sedatives

Question 13

Which vitamin is deficient in korsakoff syndrome

Answer 13

• B1 Thiamine

Question 14

What does B1 help with

Answer 14

• Thiamine (vitamin B-1) helps brain cells produce energy from sugar.
• When levels fall too low, brain cells cannot generate enough energy to function properly.
• As a result, Korsakoff syndrome may develop.

Question 15

How can alcohol misuse lead to brain damage

Answer 15

• The toxic effects of alcohol on brain cells.
• The biological stress of repeated intoxication and withdrawal.
• Alcohol-related cerebrovascular disease.
• Head injuries from falls sustained when inebriated.