(neuro) dementia

Question 1

what is the commonest cause of dementia?

Answer 1

commonest cause of dementia is Alzheimer’s disease (AD)

Question 2

what is dementia?

Answer 2

fatal, neurodegenerative disorder characterised by progressive cognitive, social and functional impairment

Question 3

what are the main causes of dementia in

a) the younger population?
b) the elderly?

Answer 3

a) early-onset dementia = rare causes

b) late-onset dementia = Alzheimer’s disease, vascular dementia

Question 4

what are the most common forms of dementia?

Answer 4

Alzheimer’s disease

vascular dementia

frontotemporal dementia

dementia with Lewy bodies

Question 5

what are the potentially reversible causes of dementia?

Answer 5

depression

alcohol-related brain damage

endocrine causes

B1/B12/B5 deficiency (especially B12 = increased cognitive deficits)

(must know these and try to treat them! to prevent progression)

Question 6

which medication has had the most significant, albeit very small, impact on dementia treatment?

Answer 6

acetylcholinesterase inhibitors

Question 7

why is it hard to diagnose dementia in clinic?

Answer 7

• disease follows a hetergenous spattern
• elderly present with multiple co-morbidities
• younger patients present more typically

(clinical history is essential!)

Question 8

what are the pathological features of Alzheimer’s disease?

Answer 8

vessel wall pathology
parenchymal ischaemic changes

neuronal tau
amyloid beta plaques
TDP-43
alpha-synuclein

Question 9

what should you ask patients in a memory clinic consultation?

Answer 9

skills:

• memory
• language
• numerical, executive, visuospatial skills
• neglect phenomena
• route finding & landmark identification

psychiatric:
- delusions, hallucinations, agitation

behavioural:

• personality and social conduct
• sexual behavior
• eating, mood, ADLs

Question 10

which type of history is key in a dementia history?

Answer 10

collateral history!

= patient may have reduced insight which can be partially made up for by taking a collateral history

Question 11

what type of dementia are subtle progressive changes associated with?

Answer 11

Alzheimer’s

Question 12

what type of dementia are large progressive changes associated with?

Answer 12

vascular dementia

Question 13

define dementia

Answer 13

severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of the underlying cause)

Question 14

what does the clinical examination for dementia consist of?

Answer 14

neurological exam (cranial nerves, upper/lower limbs, gait)

focused tests

• frontal lobe function
• MMSE

Question 15

what investigations are carried out for dementia?

Answer 15

MMSE, ACE III

bloods

amyloid PET, sMRI scan

Question 16

how does MMSE compare to ACE III?

Answer 16

ACE III takes slightly longer & is more memory focussed

Question 17

which blood tests are carried out for a patient with suspected dementia?

Answer 17

FBC, inflammatory markers

TFTs, renal profile

glucose, B12 and folate
clotting factors

syphilis serology, HIV

caeruloplasmin

Question 18

how does Alzheimer’s present on an sMRI?

Answer 18

• narrowed gyri, widened sulci
• ventricles dilated and enlargened
• medial temporal volume loss
• hippocampal volume loss (fill w CSF subsequently)

= amnestic presentation of disease

Question 19

what are the possible differentials for dementia?

Answer 19

Alzheimer’s
FTD
vascular dementia
dementia w Lewy bodies

functional neurological disorder

depression
delirium

(more acute = UTI)

Question 20

how is dementia managed?

Answer 20

1) acetylcholinesterase inhibitors
2) watch & wait (need to see progressive deterioration before clinically diagnosing)
3) treat behavioral changes (anti-psychotics, anti-depressants)
4) occupational, therapy, social services

Question 21

how does Alzheimer’s disease dementia often present?

Answer 21

subtle, insidious amnestic/non amnestic presentations

Question 22

how does vascular dementia often present?

Answer 22

related to cerebrovascular diseases with a classical step-wise deterioration +/- multiple infarcts

Question 23

how does dementia with Lewy bodies often present?

Answer 23

cognitive impairment before/within 1 year of Parkinsonian symptoms, visual hallucinations and fluctuating cognition

Question 24

how does frontotemporal dementia often present?

Answer 24

behaviour variant FTD, semantic dementia, progressive non-fluent aphasia

Question 25

what are some classic clinical signs of Alzheimer’s in a consultation?

Answer 25

lack insight into their condition and extent of their memory problems

head-turning sign = turn to family member because they do not know answer/require verification

Question 26

how does Alzheimer’s disease pathologically progress?

Answer 26

amyloid plaque levels increase (amyloid PET) = indicative of Alzheimer’s

tau levels increase = neuronal injury and dysfunction

neurodegeneration + cognitive impairment

Question 27

what is characteristic of dementia with Lewy bodies?

Answer 27

fluctuating cognition!

visual hallucinations

may have REM sleeping disorder

development of symptoms associated with Parkinson’s = increased risk of falls

Question 28

briefly explain the pathophysiology of Lewy body dementia

Answer 28

aggregation of alpha synuclein = deposition of Lewy bodies

= symptoms

Question 29

what are the classic signs of frontotemporal dementia?

Answer 29

family history of FTLD

speech disturbances

behavioural disturbances

agitation