Session 8 - Dementia

Question 1

What is dementia?

Answer 1

Progressive decline in heighten cortical function leading to a global impairment of memory, intellect and personality which affects the individuals ability to cope with the activities of everyday living.

Question 2

What are the different types of dementia?

Answer 2

Alzheimer’s disease
Vascular dementia
Front-temporal dementia
Dementia with Lewy-Bodies

Question 3

What are the reversible causes of dementia?

Answer 3

Depression
Trauma
Viatmin deficiency 
Alcohol 
Thyroid disorders

Question 4

How does dementia present?

Answer 4

Memory deficit - struggle to learn new information, short term memory loss

Behavioural - altered personality, disinhibition, labile emotions, wandering

Physical - incontinence, reduced oral intake, difficulty swallowing

Language disorder - atomic aphasia, difficulty understanding language

Visuospatial disorder - unable to identify visual and spatial relationships between objects

Apraxia - difficulty with motor planning and inability to perform learned purposeful movements

Question 5

What investigations are used to help diagnose dementia?

Answer 5

Full history and Mini Mental State Examination (MMSE)
Full neurological examination
Blood tests (for reversible causes e.g. TFT, Vit B12)
CT/MRI head
Memory clinic follow up

Question 6

What is delirium?

Answer 6

Acute confusion

Question 7

What method is used to decide whether a presentation is delirium or dementia?

Answer 7

Confusion Assessment Method - CAM Score

Question 8

What symptoms suggest delirium?

Answer 8

Acute change or fluctuating mental status
Altered consciousness - hypo/hyperactive
Inattention
Disorganised thinking

Question 9

What would a CT head of a patient with dementia show?

Answer 9

Generalised atrophy
Dilation of the ventricles

Note - features on scan don’t always correlate with clinical picture

Question 10

Describe the patterns of cognitive decline seen in vascular dementia, Alzheimer’s and Lewy Body dementia.

Answer 10

Vascular dementia - abrupt, step-wise decline in cognitive function related to vascular episode

Alzheimer’s - steady linear decline in cognitive function

Lewy-body dementia - cognitive function rises and falls

Question 11

Give a rare cause of dementia.

Answer 11

Creutzfeldt Jacob Disease

Question 12

What macroscopic changes are seen in the brains of patients with Alzheimer’s?

Answer 12

Loss of cortical and subcortical white matter causing:
Gyral atrophy - narrow gyri and wide sulci
Marked ventricular dilation

Question 13

What microscopic changes are seen in Alzheimer’s disease?

Answer 13

Amyloid-Beta Plaques (senile plaques)
Neurofibrillary Tangles (Tau tangles)

Question 14

What protein is broken down to amyloid-beta peptide with age (breakdown is increased Alzheimer’s)?

Answer 14

Amyloid Precursor Protein (APP)

Question 15

Where in the brain are Lewy bodies found in dementia with Lewy bodies?

Answer 15

Cortex and substantia nigra

Question 16

What are the key clinical features of dementia with Lewy bodies?

Answer 16

Substantial fluctuation in the degree of cognitive impairment over time.
Parkinson’s symptoms
Visual hallucinations
Frequent falls

Question 17

What are the key clinical features of vascular dementia?

Answer 17

Abrupt, step-wise decline in cognitive function related to vascular episode.

Question 18

Explain the pathology of vascular dementia.

Answer 18

Arteriosclerosis of the blood vessels supplying the brain.
Diffuse small vessel disease.
Results in decreased/cut off blood supply to a specific part of the brain.

Question 19

What is the management for vascular dementia?

Answer 19

Assess cardiovascular risk - treat hypertension/high cholesterol

Question 20

What are the different types of frontotemporal dementia?

Answer 20

Frontotemporal lobar degeneration (FTLD) with tau pathology
Pick’s disease
Familial tauopathies

Question 21

What are the key clinical features of frontotemporal dementias?

Answer 21

Alteration of social behaviour and personality; agitation, depression
Impaired judgement and insight - gambling, taking off clothes, inappropriate comments
Speech output falls eventually to a state of mutism

Question 22

What things are included in a holistic approach to management of dementia?

Answer 22

Therapies - pets, babies
Social care - risk assessments, care needs, Mental Capacity act
Memory aids - orientation boards, remembrance therapy, life stories
Drugs - cholinesterase inhibitors, memantine (most patients don’t respond to drugs, brief symptoms suppression for some)