geriatrics

Question 1

what is dementia

Answer 1

a clinical syndrome characterised by a significant deterioration in mental function that leads to impairment of normal function

progressive decline in cognitive function affecting multiple different areas including language, memory, executive function and social cognition

Question 2

how is ‘normal function’ measured

Answer 2

Through Activities of Daily Living (ADLs)
These are a series of routine activities that people should be able to do without assistance. They can be broadly divided into personal tasks and domestic tasks.

Question 3

What are the different ADLs

Answer 3

Personal: washing, dressing, toileting, continence, transferring (e.g. bed to chair)
Domestic: cooking, cleaning, shopping, managing finances, taking medication

Question 4

What is the most common underlying cause of dementia (in the UK)

Answer 4

Alzheimer’s

then Vascular, followed by DLB

Question 5

What are the main causes of dementia

Answer 5

Alzheimer’s
Vascular dementia (VD)
Dementia with Lewy Body (DLB)
Frontotemporal dementia (FTD)

Rare causes:
Parkinson’s disease dementia (PDD) Huntington’s disease (HD)
Prion disease
and others

Question 6

clinical features of dementia: cognitive impairment

Answer 6

cognitive impairment:
-poor memory
-language: receptive/expressive dysphagia
- problems with executive functioning: planning and problem solving
- disorientation

Question 7

clinical features of dementia: BPSD (behavioural and psychological sx of dementia)

Answer 7

BPSD:
- agitation and emotional lability
- anxiety and depression
- sleep cycle disturbance
- disinhibiton: socially/sexually inappropriate behaviour
- withdrawal/apathy (blunting of emotions)
- motor disturbance e.g. wandering
- psychosis

Question 8

list the RFs for dementia

Answer 8

• age: risk increases with age
• T2DM: vascular changes
• HTN: vascular changes
• smoking: vascular changes,
  inflammation, oxidative stress
• depression
• high BMI: adipocyte-secreted proteins and inflammatory cytokines
• hearing loss: from reduced cognitive stimulation
• social isolation and loneliness: reduced cognitive stimulation and poorer health outcomes in general
• education: low education = an RF

Question 9

what are the different categories of dementia and which conditions belong to each category

Answer 9

neurodegenerative disease:
- Alzheimer’s dementia
- DLB
- FTD
- Huntingdon’s disease
- Parkinson’s disease

Cerebrovascular disease:
- vascular dementia

Reversible causes:
- normal pressure hydrocephalus
- vitamin B12 deficiency
- subdural haemorrhage
- Wernicke’s encephalopathy
- hypothyroidism
- intracranial tumours
- hypoglycaemia

others:
- Prion disease
- AIDS dementia complex