Psychiatry Through The Lifecourse

Question 1

what is dementia?

Answer 1

Degenerative disease of the brain with:
cognitive and behavioural impairment
sufficiently severe to interfere significantly with social and occupational function

Question 2

most common cause of dementia is?

Answer 2

Alzheimer’s disease

Question 3

risk of Alzheimer’s with age

Answer 3

increases

Question 4

the co-occurrence of ___________ and ___________ is a hallmark of Alzheimer’s disease

Answer 4

amyloid plaques

neurofibrillary tangles

Question 5

pathophysiology of dementia - amyloid plaques

Answer 5

insoluble β-amyloid peptide deposits as senile plaques or β-pleated sheets in the hippocampus, amygdala, and cerebral cortex. Increased density with advanced disease

Question 6

pathophysiology of dementia - neurofibrillary tangles

Answer 6

consist of phosphorylated tau protein and are found in the cortex, hippocampus, and substantia nigra.

Question 7

genetics involved in Alzheimer’s

Answer 7

Chromosome 21—gene for amyloid precursor protein
Chromosome 19—codes for apolipoprotein E4. Presence of E4 alleles ^risk of AD
Chromosome 14—codes for presenilin 1 (implicated in B-amyloid peptide)
Chromosome 1—codes for presenilin 11 (implicated in B-amyloid peptide)

Question 8

cholinergic hypothesis

Answer 8

the pathological changes lead to degeneration of cholinergic nuclei in the basal forebrain (nucleus basalis of Meynert). This results in reduced cortical acetylcholine (ACh).

Question 9

name an acetylcholinesterase inhibitor

Answer 9

Donepezil

Question 10

name a NMDA receptor antagonist

Answer 10

Memantine

Question 11

list early symptoms of Alzheimer’s disease

Answer 11

Early symptoms 
Absent-mindedness
Difficulty recalling names and words 
Difficulty learning new information 
Disorientation in unfamiliar surroundings 
Reduced social engagement

Question 12

list progressive symptoms of Alzheimer’s disease

Answer 12

Progressive Disease 
Marked memory impairment 
Reduced vocabulary 
Loss of less complex speech patterns. 
Mood swings and/or apathy 
Decline in ADL’s & social skills
Emergence of psychotic phenomena.

Question 13

list advanced symptoms of Alzheimer’s disease

Answer 13

Advanced AD
Monosyllabic speech 
Psychotic symptoms 
Behavioural disturbance
Loss of bladder and bowel control
Reduced mobility

Question 14

psychiatric symptoms of Alzheimer’s disease

Answer 14

delusions (usually of a paranoid nature)
auditory/visual hallucinations
depression
behavioural disturbances
personality change

Question 15

clinical diagnosis of Alzheimer’s disease

Answer 15

presence of dementia
insidious onset
deterioration from baseline
not more likely to be accounted for by something else

Question 16

what is the purpose of routine dementia investigations?

Answer 16

primarily to exclude reversible causes of cognitive deterioration

Question 17

if delirium is a possibility, perform what test?

Answer 17

midstream urine test

Question 18

list routine dementia investigations - blood tests

Answer 18

FBC, ESR, CRP - anaemia, vasculitis
T4 and TSH - hypothyroidism
biochemical screen - hypercalcaemia or hypocalcaemia
urea and creatinine - renal failure, dialysis dementia
glucose
B12 and folate - vitamin deficiency dementia
clotting and albumin - liver function

Question 19

use of imaging in routine dementia investigations

Answer 19

to exclude other cerebral pathologies and help establish the subtype of dementia:
imaging may help to identify treatable causes such as subdural haematoma, normal pressure hydrocephalus, cerebral tumours

Question 20

list types of imaging used in dementia investigations

Answer 20

prefer MRI to assist with early diagnosis and detect subcortical vascular changes. However, CT scanning could be used