Revision - Dementia

Question 1

What is vitamin B9?

Answer 1

Folate

Question 2

What electrolyte derangement can cause metabolic induced dementia?

Answer 2

Sodium

Question 3

Give 2 endocrine causes of dementia

Answer 3

1) hypothyroidism

2) hyperparathyroidism

Question 4

What are the 4 key features of Alzheimer’s (mnemonic 4A’s)

Answer 4

1) Amnesia
2) Agnosia
3) Aphasia
4) Apraxia

Question 5

Give 3 classes of drugs that are used in the mx of Alzheimer’s

Answer 5

1) Acetylcholinesterase inhibitors e.g. donepezil, galantamine, rivastigamine

2) NMDA inhibitor e.g. memantine

3) Antidepressants

Question 6

Role of NMDA inhibitors (e.g. memantine)?

Answer 6

Blocks excessive glutamate

Question 7

There are several subtypes of vascular dementia. What is the most common?

Answer 7

Cerebrovascular infarcts

Question 8

In which type of dementia are they Parkinsonism features?

Answer 8

LBD

Question 9

What are the 4 core features of LBD?

Answer 9

1) Fluctuating cognition

2) Visual hallucinations

3) REM sleep disorder

4) Parkinsonism

Question 10

What is the core features of FTD?

Answer 10

Prominent changes in personality and behavior or language difficulties with relative sparing of memory.

Question 11

Can AChEIs & memantine be used in mx of VaD?

Answer 11

Yes - also focus on CVS risk factors

Question 12

Lewy bodies are also present in Parkinson’s disease. How does the location of these lewy bodies differ between LBD and Parkinson’s disease?

Answer 12

LBD - widespread

PD - substantia nigra

Question 13

What drugs are patients with DLB highly sensitive to?

Answer 13

Neuroleptics (i.e. antipsychotics)

Question 14

What can the use of antipsychotics in LBD lead to?

Answer 14

Can induce or worsen Parkinsonism (as suppress dopamine).

Can lead to NMS.

Question 15

Can AChEIs be used in mx of LBD?

Answer 15

Yes

Question 15

What scan can help distinguish LBD from other types of dementia?

Answer 15

Dopamine transporter scan (DaT)

Question 16

What protein is often deposited in FTD?

Answer 16

Tau protein

Question 17

What are 4 key clinical signs in FTD?

Answer 17

1) personality & behavioural changes e.g. apathy, disinhibition

2) cognitive decline

3) language impairments

4) motor abnormalities e.g. muscle weakness, dysarthria

Question 18

What are seen on an EEG in Creutzfeldt-Jakob disease?

Answer 18

Periodic sharp wave complexes

Question 19

What medications can be used to help control behavioural symptoms in FTD?

Answer 19

Selective serotonin reuptake inhibitors (SSRIs) and antipsychotics (their use must be carefully balanced against side effects).

Note - AChEIs are NOT used in FTD

Question 20

What area of the brain is most affected by cerebral atrophy in Alzheimer’s?

Answer 20

Median temporal lobes (most responsible for memory)

Question 21

4 diagnostic features for dementia?

Answer 21

1) no clouding of consciousness

2) disturbance of higher cortical functions

3) deterioration in functioning

4) >6m

Question 22

In what type of dementia is there a loss of semantic memory?

Answer 22

FTD

Question 23

How long are motor symptoms present for in parkinson’s disease before onset of cognitive symptoms?

Answer 23

At least 1 year

Question 24

If cognitive symptoms and Parkinson’s features start within a year of each other (either being present first), what is the condition?

Answer 24

LBD

Question 25

Which acetylcholinesterase inhibitor (AChEI) can help with hallucinations in LBD?

Answer 25

Rivastigmine

Question 26

What chart can be used to assess BPSDs?

Answer 26

Behavioural ABC chart

Question 27

Which is the ONLY antipsychotic licensed for the management of agitation?

Answer 27

Risperidone

Question 28

Which test is the gold standard for screening and diagnosis for cognitive impairment?

Answer 28

ACE-iii

Question 29

What 5 domains are tested in ACE-III?

Answer 29

1) attention 2) memory 3) fluency 4) language 5) visuospatial

Question 30

What score in the ACE-III indicates likely dementia?

Answer 30

< 82/100

Question 31

REM-sleep disorder is a distinctive feature of DLB. What may partners of patients report?

Answer 31

Patients and their partners may report violently acting out their dreams as many as 40 years before the onset of the dementia symptoms.

Question 32

What is seen on a CT head in Alzheimer's?

Answer 32

Widespread cerebral atrophy, mainly involving the cortex & hippocampus

Question 33

Which type of dementia is MND associated with?

Answer 33

FTD

Question 34

What is the most common ophthalmological condition associated with Charles-Bonnet syndrome?

Answer 34

ARMD

Question 35

What is Charles-Bonnet syndrome characterised by?

Answer 35

Persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis)

Question 36

Risk factors for Charles-Bonnet?

Answer 36

Advanced age Peripheral visual impairment Social isolation Sensory deprivation Early cognitive impairment