Dementia

Question 1

What are 5 conditions that may resemble dementia?

Answer 1

Normal cognitive changes with age; Mild Cognitive Impairment; Delirium; Depression; Intellectual disability.

Question 2

What are 4 things to look for when diagnosing dementia?

Answer 2

A decline in ability/change from baseline; No ongoing delirium or depression; impairment severe enough to affect function; slow deterioration over months to years.

Question 3

What is the prevalence of dementia in the population? What is the prevalence in people over 80 years old?

Answer 3

8% overall. 20% for over 80yo.

Question 4

What is the difference between Mild Cognitive Impairment and Dementia? What is the link - does MCI always progress to dementia?

Answer 4

MCI does not impact on function (eg. still independent in ADLs).
No, but if memory loss is dominant then 50% develop Alzheimer’s in 5 years.

Question 5

What are 4 most common forms/causes of dementia?

Answer 5

Alzheimer’s disease; Vascular dementia; Frontal lobe dementia; Lewy body dementia.

Question 6

What is the most common form of dementia - what % of cases? What 3 deficits are most common and what is usually affected first?

Answer 6

Alzheimer’s disease - 50-70% of cases. Memory (first), language and visuospatial/praxis.

Question 7

What kind of memory function is usually affected in Alzheimer’s disease? Episodic or semantic? Short or long term? Forming or retriving? What part of the brain is affected first.

Answer 7

Primarily episodic, short term memory and problems forming new memory. Hippocampus first - where new memory links are made.

Question 8

What are 2 pathological hallmarks of Alzheimer’s disease? What drug class may be benefical in treatment? What % may benefit and what kind of side effects are common?

Answer 8

Amlyoid plaques and neurofibrillary tangles. Cholinesterase inhibitors (eg. donepezil) may delay decline - only in 30-60% of patients. GIT side effects common (N/V diarrhoea).

Question 9

What are 6 advantages of an early recognition of dementia?

Answer 9

Educate/counsel patients & families; start community support; address other medical issues; plan lifestyle/legal issues; start treatment; minimise risk factors.

Question 10

What are 2 screening tools used in dementia? What are their relative merits? What scores suggest impairment?

Answer 10

MMSE - easy to use,

Question 11

Are neuroimaging and a neuropsych evaluation necessary when assessing a possible dementia?

Answer 11

Not essential. Imaging may be useful to exclude other pathology. Neuropsych if unsure.

Question 12

Describe the pathophysiology of vascular dementia. What class of risk factors are significant?

Answer 12

Large stroke or stroke in key area or multiple small vessel occlusions (esp in white matter). Vascular risk factors.

Question 13

What are some features of subcortical dysfunction from vascular impairment?

Answer 13

Impaired attention/concentration; difficulty initiating or stopping a thought/action; slowed processing. Motor: shuffling gait; bradykinesia. Slow slurred speech.

Question 14

What is the classic triad of features seen in normal pressure hydrocephalus?

Answer 14

Gait disturbance, incontinence and cognitive impairment.

Question 15

What is the difference in memory impairment seen in vascular dementia compared to Alzheimer’s disease?

Answer 15

Vascular - can create memories, but information coming in is poor &slowly processed. Big thing is difficulty to retrieve, but prompting helps.
ADs - can’t form new and prompting won’t help as memory never formed.

Question 16

Are consciousness and attention usually preserved in dementia?

Answer 16

Yes, perhaps only affected in late stages. Consider delirium first.

Question 17

What are 3 features that may be affected in fronto-temporal dementias? What tests may be useful and what common test may yield a normal result?

Answer 17

Behavioural changes, executive dysfunction and language disturbance. Neuroimaging (structural and functional changes) useful. MMSE doesn’t test frontal - may seem normal.

Question 18

What are 2 epidemiological features of frontotemporal dementia compared to other dementia types?

Answer 18

Earlier age than others - 45 to 65. Stronger genetic component - 50% of patients have 1st degree relative with dementia.

Question 19

What is the difference between Parkinson’s dementia and Lewy Body dementia? How much more likely is a person with Parkinson’s disease to develop dementia?

Answer 19

Same features, but called Parkinson’s if it develops >12 months after features of Parkinson’s disease. All on a spectrum.
6 times more likely to develop dementia than without disease.

Question 20

What are the features of Lewy body dementia?

Answer 20

Fluctuating cognitive ability/impaired attention - executive dysfunction; visuospatial difficulty; visual hallucinations. Not really memory.

Question 21

What drugs are people on the Parksinson’s disease dementia spectrum sensitive to?

Answer 21

Antipsychotics like haloperidol and risperidone - bad side effects.

Question 22

What are 10 required screening investigations in assessing dementia? (listed in guide book)

Answer 22

FBE, ESR, electrolytes, renal & liver function, calcium, thyroid, B12, folate, structural brain imaging.

Question 23

What diagnoses are suggested by: hallucinations and fluctuations? behavioural changes and with surgery?

Answer 23

Hallucinations/fluctuations: Lewy body dementia and delirium.
Behaviour and surgery: frontotemporal, vascular dementia.

Question 24

What diagnoses are suggested by: abrupt onset? Gait disorders?

Answer 24

Abrupt: delirium, vascular dementia.
Gait: Vascular, Parkinson’s, normal pressure hydrocephalus.

Question 25

What are 3 risk factors for Alzheimer’s disease? What are some other risk factors for dementia? What are 3 possible protective factors against dementia?

Answer 25

Age, down syndrome, genetic predisposition (Apo E4 - especially if homozygous). Vascular RF: BP, diabetes, smoking, obesity.
Protective: education, physical activity, social engagement, cognitive activity.

Question 26

What does BPSD stand for? What does it encompass?

Answer 26

Behavioural & Psychological Symptoms of Dementia. Non-cognitive symptoms associated with dementia - psychosis, delusions, depression, agitation, disinhibition.

Question 27

What are 4 things to remember when first diagnosing BPSD.

Answer 27

Assess for delirium and causes; review medications; review environmental factors; consider psychiatric diagnosis.