OPM - Dementia

Question 1

what is the prevalence of dementia

Answer 1

increases proportionally as you age. Doubling every 5 years

Question 2

what are the 4 main cognitive symptoms of dementia

Answer 2

Amnesia: loss of memory
Aphasia: difficulty with language
Agnosia: inability to recognise objects or people
Apraxia: inability to carry out physical tasks

Question 3

what are the different types of dementia (9 different types)

Answer 3

Alzheimer’s dementia
Vascular dementia
Dementia with Lewy Bodies
Frontotemporal dementia
Huntington disease dementia
CJD dementia
Parkinson’s disease dementia
Alcoholic dementia
Dementia pugilistica

Question 4

who is more at risk of alzheimers

Answer 4

females
down syndrome

Question 5

what genetic risk factors for alzheimers

Answer 5

Presenilin 1 &2, APOE ɛ4, APP

Question 6

what are some of the main risk factors for alzheimers

Answer 6

age, premorbid IQ, female, lower education, hypertension, diabetes, obesity, hypercholesterolaemia, physical inactivity, smoking
Head trauma

Question 7

what is the neuropathophysiological of Alzheimer’s

Answer 7

temporo-parietal lobe mainly affected, widening of sulci and narrowing of gyri, ventricular enlargement, senile (amyloid) plaques, neurofibrillary tangles (tau protein)

decrease acetylcholine, noradrenaline and serotonin

atrophy seen on medial temporal lobe

Question 8

who is most at risk of vascular dementia

Answer 8

men

Question 9

what are some fo the risk factors of vascular dementia

Answer 9

Hypertension, hypercholesterolaemia, diabetes

Question 10

what is more common in vascular dementia than vascular dementia

Answer 10

depression and epileptic fits more frequent and common

Question 11

what are the neuropathophysiology of vascular dementia

Answer 11

multiple large vessel disease-related stroke in critical areas

OR massive small vessel disease (more than ¼ of the total white matter)

OR multiple lacunes in the basal ganglia and frontal white matter, or bilateral thalamic lacunes

Question 12

who is at risk of lewy body dementia

Answer 12

age 75+
F=M
sporadic and rarely familial - so anyone

Question 13

what are some of the symptoms of lewy body dementia

Answer 13

parkinsons+
bilateral parkinsons with congitive impairment

Question 14

what is the neuro pathology of lewy body dementia

Answer 14

lewy bodies in cerebral cortex/substantia nigra, senile plaques, no neurofibrillary tangles

Question 15

who gets frontotemporal dementia

Answer 15

earlier age of onset 45-65
can be hereditary
memory preserved until late stage

Question 16

what are some screening tools

Answer 16

Abbreviated Mental Test Score (AMTS)
Mini Mental State Examination (MMSE)
Montreal Cognitive Assessment (MOCA)
General Practitioner Assessment of Cognition (GPCOG)
Addenbrookes Cognitive Examination (ACE-iii)
Cambridge Cognition Examination (CAMCOG)

Question 17

what are the 10 questions asked in the AMTS.
and at wat level suggests cognitive impairment

Answer 17

Age
Time to the nearest hour
An address to be repeated
Year
Name of hospital / home address
Recognition of two persons
Date of birth
Year WWI started
Name of present monarch
Count backwards from 20 to 1

<7 suggests impairment

Question 18

what are the 6 areas being assessed in the MMSE and what are the levels for normal and dementia

Answer 18

Orientation
Registration
Attention and calculation
Recall
Language
Visuospatial

27/30: normal
24-26/30: mild impairment
18-24/30: mild dementia
12-18/30: moderate dementia
<12/30: severe dementia

Question 19

what are the 5 areas being assessed in the ACE-ii and what is the cut-off value

Answer 19

Attention and orientation
Memory
Verbal fluency
Language
Visuospatial

Cut-off 82/100

Question 20

who normally carries out a neuropsychological assessment

Answer 20

clinical psychologist

Question 21

what do you need to make a diagnosis of dementia

Answer 21

history
mental state examination
Physical Examination
Cognitive Examination

Question 22

what investigations can be done for dementia and what is the gold standard

Answer 22

Dementia bloods screen: FBC, U&Es, TFT, LFT, blood glucose, folate, vitamin B12, calcium
Urine MC&S
Neuroimaging: CT, MRI, DAT scan, SPECT
Neuropsychological testing
Gold standard is autopsy

Question 23

what are the DVLA rules for driving with dementia

Answer 23

DVLA must be informed
early stages - can have a 1 year licence
Most cant drive

taxi/lorry - NO driving

Question 24

which dementia drug has possible shown signs of treating the illness

Answer 24

risperidone

Question 25

risperidone is what type of drug

Answer 25

antipsyhchotic

Question 26

what class of drug teds to be given for mild-moderate AD

Answer 26

chiolinesterase inhibitors

Question 27

what are 2 examples of cholinesterase inhibitors

Answer 27

Donepezil
Rivastigmine
Galantamine

Question 28

what class of drug (and example) is given for moderate-severe AD

Answer 28

NMDA antagonist
memantine

Question 29

what other (non treatment) drugs can be given for symptoms

Answer 29

Benzodiazepines
Anticonvulsants, antidepressants

Question 30

what do cholinesterase inhibitors do

Answer 30

stop breakdown of acetylcholine

Question 31

what are side effects of cholinesterase inhibitors

Answer 31

Nausea, vomiting, diarrhoea, dizziness, headache, muscle cramps

Question 32

who needs to use cholinesterase inhibitors with caution

Answer 32

Use with caution in gastric ulcer, heart disease, COPD

Question 33

how does memantine work

Answer 33

Blocks the pathological effects of abnormal glutamate release

Question 34

what are the side effects of memantine

Answer 34

headaches and dizziness

Question 35

who needs to avoid memantine

Answer 35

people with kidney disease and seizure disorders

Question 36

how long can you take risperidone

Answer 36

12 week corses