Key Dementia

Question 1

How would you treat Alzheimer’s first line? If mild- moderate (BIOLOGICALLY)

Answer 1

-AChE Inhibitors
(donepezil, rivastigmine, galantamine)
– memantine can be given second line

Question 2

How would you Treat severe Alzheimer’s? (Biologically)

Answer 2

– Memantine with an AChE inhibitor in moderate severe Alzheimer’s
– memantine

Question 3

How would you treat vascular dementia?

Biologically

Answer 3

– Treat reversible causes
– consider anticoagulants
Consider medication is to modify risk factors
– reduce hypertension
– anticoagulants
– lower cholesterol

Question 4

How would you treat lewy body dementia first line?

Biologically

Answer 4

You would prescribe rivastigmine or donepezil
– could give galantamine if these two are contra indicated in mild/ mod disease
- Could give memantine if AChE are contraindicated

Question 5

How would you investigate for Alzheimer’s disease

Answer 5

– History, collateral history

• Physical examination
• Blood tests: FBC, U+E
• Cognitive tests: AMTS, 6CIT
• CT HEAD (enlarges ventricles)
• ECG
• spect / csf

Question 6

How would you test for vascular dementia?

Answer 6

– History and collateral history
– cognitive assessment, mental state exam, NINS AIREN criteria
- Blood tests: FBC, urine
-Exclude reversible causes
- MRI (first choice) - looking for areas of infarction
-ECG

Question 7

How would you test for lewy body dementia?

Answer 7

– History and collateral history
– Exclude reversible causes
– cognitive assessment
CT head: generalised atrophy
– FBC, urine, CK, PNS, MSK exam, neuro exam,
– SPECT (dat) scan; Looking for dopamine transporter uptake
- I-MIBG cardiacs scintigraphy (to differentiate between Parkinson’s and Lewy body dementia)