Geriatric Medicine

Question 1

Imaging of choice for diagnosis of Lewy Body Dementia?

Answer 1

SPECT scan. Single-photon emission computed tomography is increasingly used. It is currently commercially known as a DaTscan.

Question 2

Pharmacological management for Alzheimer’s dementia?

Answer 2

Acetylcholinesterase inhibitors for mild to moderate AD:
- Donepezil
- Rivastigmine
- Galantamine

NMDA receptor antagonist is ‘second-line’ treatment for AD
- Memantine

Reserved for patients with
moderate AD who are intolerant of, or have a CI to acetylcholinesterase inhibitors, as an add-on drug to acetylcholinesterase inhibitors for patients with moderate/severe AD or monotherapy in severe AD.

Question 3

Contraindication for Donepezil?

Answer 3

Donepezil is generally avoided in patients with bradycardia and is used with caution in other cardiac abnormalities. Donepezil may cause bradycardia and atrioventricular node block (avoid in sick sinus syndrome).

Side effect of donepezil include insomnia. (Donepezil cause you to doze off)

Question 4

Features of Frontotemporal Dementia?

Answer 4

• Onset before 65
• Insidious onset
• Relatively preserved memory and visuospatial skills
• Personality change and social conduct problems.

Question 5

MMSE score for severe dementia?

Answer 5

The maximum MMSE score is 30 points.
A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia,
less than 12 indicates severe dementia.
On average, the MMSE score of a person with Alzheimer’s declines about two to four points each year.

Question 6

Which type of dementia commonly presents with visual hallucinations?

Answer 6

Lewy Body Dementia

• Progressive cognitive impairment : cognition may be fluctuating, in contrast to other forms of dementia
• Parkinsonism
• Visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

Question 7

Imaging for suspected vascular dementia?

Answer 7

MRI

Vascular dementia is the only dementia subtype where MRI is superior to CT, as cortical and subcortical ischaemic lesions are better demonstrated, and some vascular pathologies such as micro-bleeds may be otherwise missed. Therefore, if the dementia subtype is uncertain and vascular dementia is suspected, MRI is the preferred modality.