dementia

Question 1

What is dementia?

Answer 1

Severe loss of memory and other cognitive abilities that impair daily function

Question 2

What is the most common cause of dementia in elderly? Second commonest?

Answer 2

Alz in elderly followed by vascular dementia

Question 3

What is alzheimers disease? Is there a cure/treatment?

Answer 3

• Degenerative disorder with progressive cognitive, social and functional impairment.
• No cure but acetylcholinesterase inhibitors beneficial in early stages

Question 4

What are some reversible causes of dementia (mimics)?

Answer 4

Delirium, depression, vitamin B12/B1/B6, alcohol related brain damage, infections

Question 5

What is the process of dementia from start to dementia?

Answer 5

Pre-clinical period (brain changes but no symptoms) –> mild cognitive impairment –> dementia

Question 6

Why can cognition vary in clinic?

Answer 6

Affected by various things like sleep, eating, infections

Question 7

Why is it hard to accurately diagnose dementia in clinic?

Answer 7

Very heterogenous presentations. Elderly can present with various comorbidities

Question 8

What are the molecules involved in dementia?

Answer 8

Aβ amyloid, Tau, a-synuclein

Question 9

After being referred what are some things that need to be done during history taking?

Answer 9

Patient interview and collateral history - memory, visual skills, mood, motivation, eating, sexual behaviour, language, executive skills, visuo-spatial, personality etc

Question 10

What are lilliputian hallucinations?

Answer 10

Hallucinations of human, animal or fantasy (tiny figures) during wakefulness

Question 11

What is done during examination?

Answer 11

Mental & neurological examination

Question 12

What are the cognitive tests used in dementia?

Answer 12

MMSE (mini-mental state examination) +ACE III (more memory focused, 15 minutes)

Question 13

What bloods would be useful for dementia?

Answer 13

FBC, inflammatory markers, thyroid, renal function, vitamins, B12/folate, HIV, syphillis

Question 14

What would be seen on MRI in alzheimer’s?

Answer 14

narrow gyri widened sulci, dilated ventricles, medial temporal volume loss bilaterally + hippoccampal volume loss (replaced by CSF - black)

Question 15

Why are amyloid PET scans used?

Answer 15

To see amount of amyloid in brain.

Medium/high level –> more likely to have alz

Question 16

What are possible diagnoses with dementia?

Answer 16

Alz, vascular dementia, dementia with lewy bodies, depression, FTD, delirium

Question 17

Management of dementia?

Answer 17

Acetylcholinesterase inhibitors, watch/wait, treat behavioural/psych symptoms, OT/social services, specialist therapies

Question 18

What are the differences between alzheimer’s, vascular dementia, dementia with lewy bodies, fronto-temporal dementia?

Answer 18

• Alzheimers can present subtly with insidious amnestic/non-amnestic presentations.
• Vascular is related to CV disease with step wise deterioration and multiple infarcts.
• Lewy bodies involves cognitive impairment before or within a year of PD symptoms, visual hallucinations and fluctuation in cognition.
• FTD is a behavioural variant with semantic dementia, non-fluent aphasia

Question 19

What other things should be ruled out when looking at dementia?

Answer 19

depression, delirium

Question 20

Pathophysiology of alzheimers?

Answer 20

Αβ amyloid is primary event and then tau mediated neuronal injury and dysfunction

Question 21

Correlation between amyloid plaque levels and dementia?

Answer 21

more amyloid plaque levels present, more likely alz

Question 22

Looking at CSF what can be seen in alzheimer patients compared to controls?

Answer 22

• Beta-amyloid levels in CSF lower in alz than control.

- Tau levels in CSF higher in alz.

Question 23

What does alz typically involve?

Answer 23

Initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (eg hippocampus)

Question 24

What is dementia with lewy bodies associated with symptom wise?

Answer 24

Fluctuating cognition, visual hallucinations, REM sleep disorders, parkinsonian symptoms.

Question 25

What is dementia with lewy bodies caused by?

Answer 25

aggregation of alpha synuclein leading to deposition of lewy bodies

Question 26

how is lewy body dementia different to alz on MRI & DAT scans?

Answer 26

• Hippocampus and medial temporal volumes preserved in lewy body dementia
• DAT scan shows decreased availability of dopamine transporters in lewy body dementia

Question 27

What is fronto-temporal dementia associated with?

Answer 27

Non-fluent aphasia, personality changes, memory loss, changes in social behaviour, agrammatical speech

Question 28

What does an MRI show in fronto-temporal dementia?

Answer 28

• Volume loss in temporal and frontal lobes.

- Perisylvian fissure usually asymmetric