[MND] Dementia

Question 1

What is Dementia?

Answer 1

A clinical syndrome characterised by disturbance in memory, cognitive and emotional abilities severe enough to interfere with daily functioning and QOL

Question 2

Dementia is not a specific diagnosis, it refers to

Answer 2

A group of symptoms that result from the impact of diseases or conditions affecting the brain

Question 3

Epidemiology: Dementia

Answer 3

• 5 to 8% of NZ’ers aged 65 and over, and 20% of people over 80 have Dementia
• Dementia rates expected to double by 2050

Question 4

Alzheimer’s Disease is XX% of all dementia

Answer 4

50-70%

Question 5

Vascular Dementia is XX% of all dementia

Answer 5

15-25%

Question 6

Dementia with Lewy Bodies is XX% of all dementia

Answer 6

10-20% of late onset dementia

Question 7

Diagnosis?

Answer 7

Three Diagnosis Criteria

1) Memory Impairment & changes in another cognitive domain (i.e. language, thinking, judgement)
2) Severe enough to affect social and occupational functioning
3) Decline from a previous higher level of functioning

Question 8

What are the causes/main subtypes of Dementia?

Answer 8

1) Alzheimer’s Disease
2) Vascular Dementia
3) Dementia with Lewy Bodies
4) Dementia linked with other medical conditions (i.e. Huntington’s/Parkinson’s)

Question 9

What are the risk factors for Vascular Dementia?

Answer 9

Stroke and associated risk factors such as hypertension, diabetes, coronary artery disease, and smoking

Question 10

In general, what is the MAIN risk factor for Dementia

Answer 10

Advancing age in most forms of Dementia

Question 11

Prognosis (Alzeimer’s & Vascular)

Answer 11

Alzheimers: Variable, death usually from complications

Vascular: Up to 20 years from diagnosis

Question 12

Mixed Dementia is

Answer 12

a combination of Alzheimer’s and Vascular Dementia which is very common

Question 13

Pathophysiology of Vascular Dementia?

Answer 13

Loss of oxygen and nutrients due to stroke can lead to sudden onset of cognitive changes

Widespread atherosclerosis causes progressive blood vessel narrowing and ischaemic cell damage or repeated ‘mini strokes’

Question 14

Pathophysiology of Dementia with Lewy Bodies?

Answer 14

Dense tissue replaces normal tissue in nerve cells in cortical and subcortical regions causing cell death

Question 15

Clinical Presentation

EARLY STAGE ALZHEIMERS (2-3 Years)

Answer 15

• Early signs mistaken for normal ageing
• Short term memory significantly impaired
• Long term memory impairment begins
• Difficulty making decisions
• Easily distracted
• Mood changes/depression

Question 16

Clinical Presentation

MIDDLE STAGE ALZHEIMERS (2-10 years)

Answer 16

• Earlier symptoms worsen
• Increased personal and daily living dependence
• Behaviour and psychological disturbances (i.e. unusual anger)
• Further decline in memory

Question 17

Clinical Presentation

LATE STAGE ALZHEIMERS

Answer 17

• Earlier symptoms worsen
• Becoming completely dependent/inactive
• Increasing difficulty recognising family/familiar objects
• Muscle strength and voluntary movement reduced
• Increasing difficulty walking, eating, swallowing and communicating

Question 18

Clinical Presentation of Vascular Dementia

Answer 18

Symptoms vary depending on lesion location and extent on damage

Gradual cognitive decline; reasonable brain damage to occur to be noticed as dementia

Increasing symptoms with ‘mini-strokes’ can cause sudden changes such as memory impairment, then no new symptoms until another mini-stroke

Question 19

A differential diagnosis is normal ageing, why?

Answer 19

mild cognitive impairment associated with memory changes can occur with normal ageing