Dementia

Question 1

How is dementia defined?

Answer 1

Memory loss over month or years, accompanied in the later stages by aggression, agitation and apathy.

Question 2

What cognitive tested tools can be used to assess a patient for dementia?

Answer 2

Abbreviated Mental Test Score (AMTS)

1. Recalling an address at the end of the talk
2. Age
3. Time
4. Year
5. Recognize two people
6. DOB
7. Second world war start date
8. Name of the queen
9. Where are you now?
10. Count backwards from 20

or

Montreal Cognitive Assessment (MOCA)

Question 3

When assessing for dementia what should be included in the history?

Answer 3

1. Cognitive testing
2. Mental State Exam
3. Physical examination

Question 4

What is the commonest cause of dementia?

Answer 4

Alzheimer diseaes

Question 5

What is characteristic of vascular dementia?

Answer 5

Very sudden onset
Step wise deterioration.
Vascular history : strokes, TIA
Hypertension and cardiovascular events may have occured.

Question 6

What is characteristic of lewy body dementia?

Answer 6

Detailed visual hallucinations of small people and animals
Later parkinsonism may occur
Fluctuating cognitive impairment

Question 7

When taking a history from an informant, what can be useful for determining the type of dementia?

Answer 7

A TIMELINE of events ; what did they notice first, and what particular aspects the patient struggles with.
How does it affect activities of daily living

Question 8

What is characteristic of fronto temporal dementia on a brain CT?

Answer 8

Fronto temporal atrophy

Question 9

What is characteristic of fronto temporal dementia?

Answer 9

Executive impairment
Behavioural and personality change
Disinhibition
Emotional unconcern
Visuospatial and working memory usually spared
Like sweet foods!!

Question 10

What are the differential diagnoses for dementia?

Answer 10

Depression
Mild cognitive impairment
Delerium
Infection - UTI
Tumour

Question 11

What is characteristic of a diagnosis of Alzheimers diseaes as opposed to other dementias?

Answer 11

Global, progressive loss of functioning

Question 12

What are the characteristics of alzheimers disease?

Answer 12

Visuo-spatial loss
Memory loss
Verbal ability loss
Executive impairment
lack of insight

Question 13

What are some of the symptoms in later stages of dementia?

Answer 13

Aggression
Agitation
Depression
Psychosis
Agnosia

Question 14

Which peptide accumulates in Alzheimers disease?

Answer 14

Beta amyloid peptide

Question 15

How does accumulation of B-amyloid peptide cause neuronal damage?

Answer 15

Amyloid deposits cause neuronal damage

Loss of neurotransmitter ACH

Question 16

What are the risk factors for Alzheimer disease?

Answer 16

Family History
Downs syndrome (AD is inevitable in downs syndrome)
Vascular risk factors (BP, lipids, diabetes)
Depression
Lonlieness

Question 17

How is the pharmacological treatment of alzheimers disease categorised?

Answer 17

Behavioural - depression / hallucinations / delusions / anxiety / agitation / apathy
Cognitive symptoms - executive functioning decline / memory / visuo spacial awareness

Question 18

What medications can be used to help with the cognitive symptoms of Alzheime’sr?

Answer 18

Cholinesterase inhibitors - stopping further breakdown of ACH
Only delays the worsening of symptoms. It does not cause the damage to get better.

Question 19

Name two cholinesterase inhibitors

Answer 19

Rivastigmine

Galantamine

Question 20

What medications can be given for the behavioural symptoms of Alzheimer’s?

Answer 20

Depression - SSRI
Psychosis - antipsychotics
Agitation - lorazapan
Psychosocial interventions - CBT / talking therapies / care coordinator / day services