Types

Question 1

What are the diagnostic requirements for dementia?

Answer 1

Memory impairment for at least 6 months

Plus impairment in one or more of the following:

• Executive functioning eg logic, reasoning
• Language eg repeating
• Praxis - learned motor tasks
• Gnosis - recognising faces and objects

Question 2

What are the 5 mains types of dementia?

Answer 2

1. Alzheimers
2. Vascular
3. Lewy body
4. Temporofrontal
5. Other eg HD, CJD, HIV

Question 3

What are some differential diagnosis for dementia?

Answer 3

• DEPRESSION - hard to differentiate sometimes
• Delirium eg infection, constipation, alcohol
• Mild cognitive impairment - doesnt affect activities of daily living
• Physical illness - Hypothyroid, thiamine deficiency, Wernickes, neoplasm, renal impairment and toxicity

Question 4

What are the risk factors for Alzheimers Disease?

Answer 4

Female

Age

Genetics - Presenillin/Apolilipoprotein

Question 5

What is the pathophysiogy of Alzheimers Disease??

Answer 5

• Amyloid cascade hypothesis - Insoluble amyloid plaques which are toxic to the brain aggregate - they come from Amyloid precursor protein (part of cell membrane).
• These encourage tau protein to form Neurofibrilliary tangles
• Cerebral cortex atrophy
• This all causes cerebral cortex atrophy and ACH disruption to amygdala and hippocampus and disrupts memory

Question 6

What do neurofibrilliary tangles and senoid plaques look like?

Answer 6

Question 7

How is Alzheimers Disease diagnosed?

What are the cardinal signs?

Answer 7

DIagnosis of exclusion

Insiduous, progressive, gradual decline

LOSS OF NEW MEMORIES

Question 8

What are the risk factors for vascular dementia?

Answer 8

Age

male

Cardiovascular risk factors

Question 9

What is the pathophysiology of vascular dementia??

Answer 9

Focal or widespread embolism causing cerebral infarction

Question 10

What are the cardinal features of vascular dementia?

Answer 10

Abrupt onset

Stepwise decline

Question 11

How is vascular dementia diagnosed?

Answer 11

Neurological signs and vascular disease on imaging

Question 12

What is Dementia with Lewy bodies?

Answer 12

A continuum between Alzheimers and Parkinsons

Question 13

What is the pathophysiology of Dementia with Lewy bodies?

Answer 13

Lewy bodies form in brain and affect dopaminergic and acetylcholinergic neurons

Dopamine - PD

ACH - Alzheimers

Both - Dementia with Lewy bodies

Question 14

What are the diagnostic features of Dementia with Lewy bodies?

Answer 14

Dementia, plus two of the following

• Visual hallucinations
• Parkinsonism
• Reduced alertness

Question 15

What is frontotemporal dementia?

Answer 15

Atrophy of frontal and temporal lobes

Question 16

What is an example of frontotemporal dementia?

Answer 16

Picks Disease

Question 17

What are the features and what is an example of frontotemporal dementia?

Answer 17

Early onset

Loss of language and personality/behaviour changes whilst memory remains intact

Question 18

How is dementia assessed?

Answer 18

Mini mental state exam

CT brain - not diagnostic but can exclude other pathologies

Question 19

What is a differential for dementia where the key symptom is urinary incontinence?

Answer 19

Hydrocephalus