Geriatrics - Dementia

Question 1

What can cause dementia?

Answer 1

• Alzheimer’s (most common cause)
• Vascular dementia
• Lewy body dementia

Question 2

What are some rare causes of dementia?

Answer 2

• Huntington’s disease
• Creutzfeldt-Jakob disease (prion infection) causing rapid degeneration of the brain
• Pick’s disease (atrophy of frontal and temporal lobes)
• HIV

Question 3

What important differentials should be considered for dementia?

Answer 3

• Hypothyroidism
• B12/folate/thiamine deficiency
• Syphilis
• Brain tumour
• Normal pressure hydocephalus
• Subdural haematoma
• Depression
• Chronic drug use e.g. alcohol or barbituates

Question 4

How is dementia diagnosed?

Answer 4

NICE recommends

• 10-Point cognitive screener
• 6-Item cognitive impairment test

Tools also used:

• Abbreviated mental test score
• General practitioner assessment of cognition
• Mini-mental state examination

Question 5

What mini-mental state examination score suggests dementia?

Answer 5

24 or less out of 30

Question 6

How is dementia managed?

Answer 6

Primary care
- Blood screen sent to exclude reversible causes
- Old age psychiatrists

Secondary care
- Imaging to exclude reversible conditions e.g. subdural haemtoma, normal pressure hydrocephalus

Question 7

What blood screen is used for dementia?

Answer 7

FBC
U&Es
LFTs
CRP
Calcium
Glucose
TFTs
Vitamin B12 and folate

Question 8

What is Pseudodementia?

Answer 8

Dementia-like symptoms that come on acutely due to underlying conditions such as depression

Question 9

What do patients with pseudodementia say when questioned?

Answer 9

I don’t know