Psychiatry: Dementia

Question 1

Alzheimers disease, Parkinson’s disease and Lewy body all types of what

Answer 1

Degenerative forms of dementia

Question 2

What are the key features of Alzheimers (name the additional ones if you can)

Answer 2

Agnosia - difficulty recognising objects, people, sounds
Apraxia - difficulty using objects
Amnesia - memory loss, first short term memory of time
Aphasia - expressive (Brocas) or receptive (wernicke’s), lexical anomia (word finding difficulty)
Associated behaviours: labile mood, irritable, sexually disinhibited, incontinence, depression, disorientation, personality change
Also Hallucinations + Delusions

Question 3

What are the early signs of Alzheimers disease

Answer 3

Forgetfulness
Disorientation in self
Change in behaviour e.g. wandering

Question 4

What are the key features on an Alzheimers MRI

Answer 4

Cortical atrophy (parietal and temporal), 
B-amyloid plaques and NFT in cortex

Question 5

What are the MMSE ranges for Alzheimers Disease

Answer 5

Mild = 21-16
Mod = 20-10
Severe < 10

Question 6

What is the clinical course of Alzheimers

Answer 6

Gradual and progressive

Question 7

How does early onset Alzheimer’s differ from normal

Answer 7

Early onset < 65yo
Rapid and severe detrioration in cognition with severe apraxia and agnosia
Poor prognosis

Question 8

What are the 6 RF for poor prognosis in Alzheimer’s

Answer 8

Male 
Age < 65yo 
Parietal lobe damage 
Severe focal deficit e.g. apraxia 
Observed depression 
Prominent behavioural problems

Question 9

What is the 1st line treatment for Alzheimers (mild-mod)

Answer 9

Mild-moderate

1. ACHe-i (increase Ach in cortex)
   - Donepazil, rivastigmine, galantamine

Question 10

What is 2nd line for Alzheimers (mod-sev)

Answer 10

Mod-severe

2. NMDA receptor antagonist, Memantine

Question 11

What are the three most common types of dementia

Answer 11

1. Alzheimers
2. Vascular
3. Lewy Body

Question 12

What is LB dementia

Answer 12

Degenerative, mixed-type dementia
- LB deposits within the basal ganglia of the midbrain a/w neuronal change (decrease in Ach transmission) and vascular changes (30%)

Question 13

In what demographic does LB occur

Answer 13

50-83yo, M>F

Question 14

What are the cardinal symptoms of LB dementia

What are the other symptoms

Answer 14

1. Parkinsonism
2. Fluctuating cognition and consciousness (mute and unresponsive for periods)
3. Hallucinations and delusions

Depression, falls and syncope, Antipsychotic sensitivity

Question 15

What are the main treatment options for LB

Answer 15

1. ACHe-i = donepazil, rivastigmine, galantine

2. clonezapm = for sleeping difficulties

Question 16

What should you be absolutely cautious with when treating LB dementia

Answer 16

DO NOT GIVE A/P drugs!! They will cause:

1. Permanent parkinsonism
2. Neuroleptic malignant syndrome
3. increase risk of mortality

Question 17

What should you be absolutely cautious with when treating LB dementia

Answer 17

DO NOT GIVE A/P drugs due to A/P sensitivity!! They will cause:

1. Permanent parkinsonism
2. Neuroleptic malignant syndrome
3. increase risk of mortality

Question 18

What are the causes

Answer 18

Thromboembolic events or infarcts of s/m cerebral vessels

Question 19

Which demographic are at particular risk of Alzheimers

Answer 19

Down syndrome - chr.21 holds gene for B-amyloid plaques

Question 20

What is the clinical course of LB dementia

Answer 20

Gradual and progressive with fluctuating cognition and consciousness

Question 21

What are the three clinical syndromes of vascular dementia

Answer 21

1. Cognitive impairment following single stroke
2. Multiple infarct dementia (MID)
3. Binswanger disease (progressive small vessel disease)

Question 22

Explain the pathology and symptoms of MID

Answer 22

multiple strokes cause step-wise deterioration of cognition

Period between strokes are stable

Question 23

What is the region of the brain associated with the highest risk of vascular dementia following a single stroke

Answer 23

Mid brain and thalamic region

Question 24

Explain the pathology and symptoms of Binswanger disease

Answer 24

multiple micro-vascular infarcts perforate vessels in brain –> white matter changes and lacunae formation

Gradual and progressive deterioration in cognitive function, psychomotor retardation and motor dysfunction

Question 25

What is the treatment of vascular dementia

Answer 25

1. determine cause
2. daily aspirin - slow progression
3. statin
4. HTN control (CCB) - not BB due to rhabdomyolysis risk
5. optimise diabetic control
6. Lifestyle changes - diet, exercise etc.