Week 4- Dementia - Overview and Epidemiology

Question 1

what is dementia?

Answer 1

“an acquired generalised impairment of
intellect, memory and personality, but with no impairment of
consciousness can affect daily activity”.

or

This is the name given to a group of chronic, progressive, degenerative
organic brain disorders all with a common characteristic: Continuous
deterioration in cognitive function leading to a gradual decrease in
intellectual capacity.

Question 2

what are the clinical features of dementia?

Answer 2

Features:
 Impaired memory and poor cognitive function
 Impaired thinking
 Disturbed behaviour
 Lack of insight
 Lack of spontaneity
 Poverty of speech
 Low mood

Question 3

what are the clinical features of dementia? Impaired memory and poor cognitive function:

Answer 3

 forgetfulness
 poor attention
 disorientation in time and place
 agnosia (recognition of objects, people, self)
 dysphasia (names of things)
 dyspraxia (understanding commands)

Question 4

what are the clinical features of dementia? Impaired thinking:

Answer 4

Impaired thinking:
 Slow
 Impoverished
 Incoherent
 Rigid

Question 5

what are the clinical features of dementia? disturbed behaviour:

Answer 5

Disturbed behaviour:
 Disorganised
 Inappropriate
 Distracted
 Restless
 Antisocial

Question 6

what is the prevalence of dementia?

Answer 6

 It is estimated that more than 850,000 people currently diagnosed with
Dementia in the UK
 By 2021, this figure is likely to reach over 1 million people and by 2051 over 2
million
The prevalence increase with age, affecting approximately
• 1 in 1,400 of those aged 40-64
• 1 in 100 of those aged 65 – 69
• 1 in 25 of those aged 70 – 79
• 1 in 6 of those aged 80 years and over

Question 7

what are some main facts about dementia?

Answer 7

• Two thirds of people living with dementia do so in the community
• Two thirds of care home residents have a diagnosis of dementia
• One quarter of acute hospital beds are occupied by someone with a diagnosis
of dementia
• The Dementia UK report 2014 states that dementia care cost the taxpayer
£26.3 billion per annum

Question 8

what are the risk factors of dementia?

Answer 8

 Older Age
 Poor Cognitive Performance
 Low BMI or overweight
 Slow Physical Performance
 Not eating your Veg!
 Lack of alcohol consumption
 Diabetes
 Depression and Bipolar
 apoE4
 MRI showing white matter disease
 Ventricular enlargement
 Carotid artery thickening
 History Of bypass surgery

Question 9

what parts of the population is affected by dementia?

Answer 9

 Learning Disabilities- Have a higher risk of suffering from Dementia due to
premature aging. Also increased genetic risk
 Parkinson’s
 BME- Greater risk of early onset

Question 10

what is the mortality for dementia?

Answer 10

 Survival rate from diagnosis is approx. 5-8 years
 In 2017, Deaths where Dementia was mentioned on the death certificate
accounted for 903 deaths per 100,000 population

Question 11

how many types of dementia are there? how many common ones?

Answer 11

There are over 400 types of dementia. In accordance to DSM-V, the 4 most common are

Question 12

what are the 4 main types of dementia?

Answer 12

 Alzheimer’s disease/ Dementia ~ 50-60% of cases
 Vascular disease/Dementia ~ 20-25% of cases
 Lewy body disease/Dementia ~15-20% of cases
 Frontotemporal lobar degeneration/Frontotemporal Dementia ~ 7% of cases

Question 13

what are other classifications for dementia?

Answer 13

Traumatic brain injury,
Substance/medication induced, HIV infection, Prion disease,
Parkinson’s disease, Huntington’s disease, due to another medical
condition, mixed aetiologies, unspecified

Question 14

what are the main clinical features of Alzheimer?

Answer 14

-memory impairment which will have a gradual onset and continuous decline
-may have other dementia
- Aphasia, problems with lanuage and speech
- Apraxia, problems to do familiar movement on command
- Agnosia, loss of ability to recognise faces, voices and places
- Disturbance of executive functioning, struggle to plan and concentrate, problem solving, time management
-Other features may include:
Depression, Psychosis, Behavioural and
Personality Changes

Question 15

what is the progression and staging of Alzheimer disease, within year 1-3 (early stage) what may the patient experience symptom wise?

Answer 15

-language difficulties
-depression
-losing direction when out and about
-Recent Memory Impairment
and Forgetting Names
-Increased Number of
Accidents whilst Driving
-Impaired Activity
of Daily Living

Question 16

what is the progression and staging of Alzheimer disease, within year 2-7 (mid stage) what may the patient experience symptom wise?

Answer 16

-aphasia, problems with speaking, typing
-amnesia, memory loss, problems forming new memories
-Inability to bathe,eat,toilet or
dress without assistance
-Inability to calculate
solutions and problem
solve
-Behavioural and
Psychiatric Changes

Question 17

what is the progression and staging of Alzheimer disease, within year 2-7 (late stage) what may the patient experience symptom wise?

Answer 17

-seizures
-Short and Long Term
Memory Loss
-Double incontinence help when toileting
-Mutism or nonsensical
speech
-Complete
dependence on
others
-Rigid Posture

Question 18

what is the aetiology of Alzheimer?

Answer 18

Demographic Factors
 Increasing Age
 Family History
 Down Syndrome
Genetic Factors
 Down Syndrome
 ApoE4
Environmental and Medical Risk Factors
 Low IQ
 Previous Head Injury
 Cerebrovascular disease
 Depression
 Diabetes Mellitus
 Obesity

Question 19

what is vasular dementia?

Answer 19

2nd most common
 Sudden onset followed by a step wise progressive decline
 Onset is usually around late 60’s-70’s
 Caused by an infarct, generally there is a history of hypertension, stroke and TIA
 Approx 10% of people develop Dementia after a first stroke and more than a 1/3 after
recurrent strokes
 prevention is the best treatment (good management of blood pressure, diabetes, heart
disease, cholesterol, smoking)

Question 20

what are the clinical features of vascular dementia?

Answer 20

 Emergent of Emotional and Personality changes ( inc Depression), followed by
memory impairment
 Apraxia
 Agnosia
 Dysarthria, muscles used for speech become weak
 Dizziness

Question 21

what are some other focal neurological signs ( which are not present in AD)?

Answer 21

 Gait disturbance – in Late VaD there is a shuffling gait which differentiates
from Parkinson’s by it’s broad base and preserved arm swing
 Weakness of extremities
 Extensor plantar response
 Pseudobulbar palsy
 Exaggeration of deep tension reflexes

Question 22

what are some risk factors for vascular dementia?

Answer 22

 Family history
 Male sex
 Hypertension
 History of stroke or transient ischaemic attacks (TIAs)
 Diabetes mellitus (DM)
 Smoking
 Atrial fibrillation (AF)
 Recent studies have shown similar risk factors as for AD

Question 23

what is Lewy Body dementia? features

Answer 23

 Progressive cognitive decline, especially in attention and visuospatial ability
 A variant of Klezmers disease, more common in men
 Persistent and well-formed visual hallucinations, sometimes auditory
 Early gait disturbances
 Parkinson’s type features
 Other psychotic feature

Question 24

what are other supportive features of Lewy Body dementia?

Answer 24

 Repeated falls
 Syncope
 Transient loss of consciousness
 Systemised delusions
 Non-visual hallucinations
 REM sleep behaviour disorder
 Depression
 Extremely sensitive to the side-effects of antipsychotics

Question 25

what is the aetiology of lewy body dementia?

Answer 25

 Closely related to Parkinson’s disease and both characterised as
synucleinopathies
 Family History
 No known environmental risk factors

Question 26

what is frontotemporal dementia?

Answer 26

 Most common form of presenile Dementia
 Onset between 45-70 years of age
 Frontal lobe pathology responsible for behavioural and personality changes
 Temporal lobe pathology responsible for language disorder

Question 27

what is the onset and progression of frontotemporal dementia?

Answer 27

 Insidious onset, slow progression
 Early loss of insight
 Early signs of disinhibition
 Distractibility and impulsivity

Question 28

what are some language and effective features of frontotemporal dementia?

Answer 28

Language Features
 Progressive decrease in speech output
 Echolalia
 Perseveration
Affective Features
 Depression
 Apathy
 Emotional blunting

Question 29

what is the aeitiology of Frontotemporal Dementia?

Answer 29

 Primarily Unknown
 Mutations in progranulin (GRN)
 TAU- linked to Chromosome 17
 TDP-43 and C90RF72 genes

Question 30

how is the clinical diagnosis and the importance of early diagnosis of dementia?

Answer 30

 Reversible/treatable conditions such as pseudo-dementia are detected and
excluded
 Patient and family have time to plan for the future
 Personal affairs may be put in order while the individual still has insight.
 Able to discuss discussions their future care while they still have insight and
agree Advanced Directives for example.
 Early access by the person with dementia and their family, to support groups,
e.g. Alzheimer’s disease Society
 Treatment that may slow progression of the disease can be more effectively
targeted to the right stage of the disease.
 Complete history, including medical, physical and mental state examinations
 Review any medicines being taken as those with anticholinergic and sedative
side effects can impact adversely on cognition
 Diagnostic criteria from either DSM or ICD have been met
 Psychometric tests have been performed
 neuroimaging has been performed if possible e.g MRI and CAT scans

Question 31

what are some investigations for establishing the cause of dementia and potential diagnosis?

Answer 31

Primary Care
 FBC
 U and E’s
 LFT’s
 CRP
 Calcium and Phosphate
 Thyroid Function
 Vitamin B12 and Folate
 Urine dipstick
 Blood Glucose
 Temperature

In Secondary Care
 MRI and CT scan
 Urinalysis
 HIV status
 Neuropsychological assessment
 EEG

Question 32

what are some clinical screening tools that can be used to diasnose dementia?

Answer 32

 Mini-Mental State Examination- MMSE
 Abbreviated Mental Test Score-AMTS
 Alzheimer’s Disease Assessment Scale- cognitive subscale- ADAS-cog
 Addenbrooke’s Cognitive Examination 3 –ACE3 or mini ACE

Question 33

what is the Mini-Mental State Examination- MMSE?

Answer 33

-most common tool used
 MMSE to assess cognitive function and decline
 MMSE tests memory, attention, calculation, orientation, language, ability to
follow command and praxis
 Primarily used to aid diagnosis of Alzheimer’s and recommended by NICE to
assess the severity of AD and response to Pharmacological treatment
 Takes less that 10-15 minutes to perform
 8 Questions
 Score 0-30
 Has limitations