Dementia

Question 1

Features of common dementia Syndromes

Answer 1

Alzheimer
- Insidious onset progressing to profound memory impairment, dysphasia, dyspraxia, personality change
Frontal
- Personality change, Social disinhibition, Apathetic and withdrawn
- Lewy Body - VIsual hallucinations, spontaneous motor parkinsonism, fluctuating mental state in absence of delerium
- Vascular - Starts suddenly. Focal neurological signs with evidence of CVA
Alcohol associated - Deficits in new learning and in frontal function

Question 2

Pharmacological therapies for Alzheimers Disease

Answer 2

1 Acetylcholinesterase inhibitors
- E.g. Donepezil 5mg PO OD, Galantamine 8mg PO OD, Rivastigmine 1.5mg PO BD
- Decrease breakdown of acetylcholine, reduce deficiency in cholinergic neurotransmitter activity
- MMSE must be > 10
- AE - Nausea, vomiting, diarrhoea, anorexia, depression, headache, muscle cramps
- Toxicity - Dizziness, drowsiness, bradycardia, syncope, salivation, convulsions
2 NMDA-Receptor antagonist
- E.g. Memantine 5mg PO OD
reduces glutamate-induced neuronal degradation in Alzheimers
- Recommended 2nd line if unable to tolerate AChI.
- MMSE 10-14
- SE - GI Upset, confusion, dizziness, headaches, agitation
- Contra - Seizures

Question 3

Management of Vascular Dementia

Answer 3

• Appropriate antithrombotic therapy according to stroke subtype.
• Progressive decline not attributable to Stroke? Commence donepezil 5mg PO OD

Question 4

Non-pharmacological management of increased aggression in context of dementia

Answer 4

• Identify and reduce triggers of aggression
• Provide calm, low-stimulating environment
• Simplify instructions when conversing
• Offer positive reinforcement for good behaviour
• Provide familiar environment (Photos of family, consistent staff / routine)
• Time orientation aids
• Integrated regular leisure activities (Arts, crafts, gardening)
• Anxiety management (Reassurance from staff and family)

Question 5

Risk factors for developing dementia

Answer 5

• Sedentary Lifestyle
• Excessive alcohol intake
• Smoking
• History of head injury
• Low level of social engagement
• Family history of dementia
• History of depressed mood
• Exposure to air pollution.