Dementias

Question 1

Common causes

Answer 1

Alzheimer’s disease

Cerebrovascular disease (multi-infarct dementia)

Lewy body dementia

Question 2

Rarer causes

Answer 2

Huntington’s

CJD

Pick’s disease (atrophy of frontal and temporal lobes)

HIV

Question 3

Important differentials

Answer 3

Hypothyroidism

B12/ folate/ thiamine deficiency

Syphilis

Brain tumour

Normal pressure hydrocephalus

Subdural haematoma

Depression

Chronic drug use

Question 4

Risk factors for ALzheimer’s

Answer 4

Increasing age

Family history

Caucaisan ethnicity

Down’s syndrome

Question 5

Alzheimer’s pathological changes

Answer 5

Macroscopic: widespread cerebral atrophy (cortex and hippocampus)

Microscopic: cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles causing aggregation of tau protein

Biochemical: deficit of acetylcholine

Question 6

Non-pharmacological Alzheimer’s management

Answer 6

Range of activities to promote wellbeing

Group activities for cognitive stimulation

Reminiscence therapy

Question 7

Alzheimer’s pharmacological management

Answer 7

Acetylcholinesterase inhibitors: donepezil, galantamine, rivastigmine

Memantine (NMDA antagonist) second line

Question 8

Vascular dementia risk factors

Answer 8

History of stroke or TIA

AF

HTN

DM

Hyperlipidaemia

Smoking

Obesity

Coronary heart disease

DH of stroke of CVD

Question 9

Vascular presentation

Answer 9

Stepwise deterioration of cognitive function

Focal neurological abnormalities

Difficulty with attention and concentration

Seizures

Memory disturbance

Gait disturbance

Speech disturbance

Emotional disturbance

Question 10

Management of vascular dementia

Answer 10

Detect and address cardiovascular risk factors

Cognitive stimulation programmes, music and art therapy

Manage challenging behaviours (pain, overcrowding, communication)

Only consider AChEi if suspected comorbid Alzheimer’s disease, Parkinson’s disease of LBD