Introduction to dementia

Question 1

What is dementia?

Answer 1

An umbrella term for conditions that causes impaired cognitive thinking, beyond that of normal ageing to the point that it interferes with every day life.

Question 2

What are the key features of dementia?

Answer 2

Is progressive
Is a global impairment
Effects all cognitive processes.

Question 3

Give an overview of the prevalence of dementia in the UK.

Answer 3

944,000 people have dementia in the UK
1 in 14 over the age of 65yrs will develop dementia, 1 in 6 over the age of 80yrs will develop dementia.

Question 4

What are some symptoms of dementia?

Answer 4

Short term memory loss
Develops into long term memory loss
Cognitive function also inlcudes difficulty concentrating. problems planning/problem solving, issues with language/communication, problems judging distances, mood changes and difficult to regulate emotions
Struggle with familiar daily tasks

Question 5

What are the different types of dementia?

Answer 5

Alzhiemers
Vascular
Mixed
Dementia with Lewy bodies/ parkinsons disease dementia
Frontotemporal dementia
Rarer types developing from huntingtons disease, corticobasal degeneration

Question 6

What type of dementia is the most common?

Answer 6

Alzhierms - 60%
Vascular - 20%
Mixed - 22%

Question 7

What are the main components of diagnosing dementia?

Answer 7

Clinical history ***
Examination - mental state (depression) and neuro exam
Cognitive testing
Imaging and investigations - structural and functional imaging icluding a CT, MRI, fMRI, SPECT, DAT and bloods

Question 8

What is the GPCOG cognitive tests for when diagnosing dementia?

Answer 8

GPCOG - in GP surgery, basic memory tasks for patients, may also require an informatn questionnaire, scores above 8 indicate cognitive impairment, below 5 is normal, between these requires the informat survey - score below four indicates impairment

Question 9

What is an MMSE test?

Answer 9

A mini mental state examination, scored out of thirty
Lower score indicates cognitive impairment

Question 10

What is an Addenbrookes test?

Answer 10

A test of mental cognition
Recall basic time date, name etc
Recall names of drawn objects
Follow basic instruction
Ability to draw image of a word

Question 11

Why might a CT scan be done of a patient with suspected dementia?

Answer 11

Look at the shape and size of the brain, shrinkage of brain regions is often expected.
Eliminate tumours, stroke, hydrocephalus etc
Often see enlarged ventricles, tissue around the ventricles die.

Question 12

What is an fMRI?

Answer 12

Is a functional MRI
Measures regional blood flow in the brain,presents as colour gradient on the image.
Indicates which areas of the brain are active compared to others.
Used to measure response to a specific stimuli

Question 13

What is a SPECT?

Answer 13

Is a CT scan where a radioactive tracer is injected into the blood.
Unlike a PET CT the tracer remains in the blood and does not travel into adjacent tissue
Allows the blood vessels to be studied.
Used to measure general activity

Question 14

What is a DAT?

Answer 14

Drug injected into bloodstream, highlights dopaminergic receptors and dopmaine containing neurons

Question 15

What might a blood test be looking at in a dementia case?

Answer 15

Blood test is to rule out other causes of symptoms
Look afor B12 deficiency, thyroid function, liver and kidney function.

Question 16

What other investigation may be done for a suspected dementia case?

Answer 16

Full blood count
Urea, creatine and electrolytes
Liver function
Thyroid function
B12 and folate
Blood glucose
CT/MRI

Question 17

What are some risk factors for dementia?

Answer 17

Age
Genetic link with early onset
Gender - women more
Lifestyle - smoking, alcohol and diet
Hypertension, diabetes, cardiovascular disease
Treating depression ( depression episodes in later life can increase dementia risk)
Head injury

Question 18

What are some of the brain changes that occur in dementia?

Answer 18

Tau protein - increasing clumps together inside neurons.
- Amyloid deposits - accumulates between neurons , eventually trigger microinflammation in the brain
- loss of tissue atrophy in medial temporal lobes

Question 19

What are some early signs of dementia?

Answer 19

Repetitive
Forgetful
Speech problems
Trouble completing daily tasks
Personality changes
More reliant on others
Disoriented
Neglecting social conventions

Question 20

What are some of the signs of late dementia?

Answer 20

Fragmented thinking
Speech very distorted or mute
Swallowing difficulties
Fraility
Reliant on others for all care.

Question 21

What are some behavioural and psychological symptoms of dementia?

Answer 21

Agitation
Aggression
Hallucinations
Delusion
Repetitive, non goal orientated activity
Mood disturbances
Anxiety
Disinhibited behaviours (not following social constructs)

Question 22

What are the pharmacological treatments for dementia?

Answer 22

Acetylcholinesterase inhibitors - 1st line Donepezil
NMDA receptor antagonist - Memantine - blocks glutamate neuron activity
These are not curative, they prolong the time a person can be independent

Question 23

What are some non-pharmacological treatments for dementia?

Answer 23

Cognitive stimulation Therapy
End of life care planning
Encourage social contact
Validation therapy
Reminiscence therapy