Alzheimer's Disease and Dementia

Question 1

What is the most common type of dementia?

Answer 1

Alzheimer’s disease (~60%)

Question 2

What is the second most common type of dementia?

Answer 2

Vascular dementia (~20%)

Question 3

What is the third most common type of dementia?

Answer 3

Lewy body dementia (~10%)

Question 4

What might cause reversible dementia?

Answer 4

▪️Chronic alcohol abuse
▪️Deficiencies
▪️Metabolic/endocrine changes
▪️Infection
▪️Neoplastic

Question 5

What are the three pathological hallmarks of Alzheimer’s disease?

Answer 5

▪️Beta amyloid deposition (plaques)
▪️Neurofibrillary tau tangles
▪️Neuronal loss

Question 6

In Alzheimer’s disease, where is atrophy most apparent?

Answer 6

The medial temporal lobes

Question 7

What is vascular dementia?

Answer 7

Arteriosclerosis and neuronal death due to occlusion of the arteries and reduced blood flow to the brain (multiple large cerebral infarcts)

Question 8

Give examples of cardiovascular events that may lead to vascular dementia.

Answer 8

▪️Embolus
▪️Vasculitis
▪️Haemorrhage

Question 9

What scan would be used to look for Lewy body dementia?

Answer 9

DAT scan to look at dopamine uptake, particularly in the basal ganglia and substantia nigra

Question 10

What is the main pathological finding in Lewy body dementia and which proteins are involved?

Answer 10

Lewy bodies - alpha-synuclein and ubiquitin

Question 11

What are the three main features needed for clinical diagnosis of dementia?

Answer 11

▪️Cognifive failure (> 6 months)
▪️Deterioration in functioning
▪️Evidence of progression

Question 12

What is the pattern of cognitive failure linked to in early stage dementia?

Answer 12

The distribution of brain and neurotransmitter dysfunction

Question 13

At what point in dementia progression would you see regional and global brain atrophy?

Answer 13

Later stages

Question 14

What brain changes would you see in the later stages of dementia?

Answer 14

Global brain atrophy

Question 15

What deficit would be most apparent with medial temporal and hippocampal atrophy?

Answer 15

Memory

Question 16

What deficit would be most apparent with lateral temporal atrophy?

Answer 16

Language

Question 17

What are the four ‘A’s of dementia?

Answer 17

Amnesia
Aphasia
Apraxia
Agnosia

Question 18

What types of memory are better/longer preserved in dementia?

Answer 18

Long term memory and motor memory

Question 19

What is apraxia?

Answer 19

Inability to preform skilled movememts and intentional acts despite intact motor and sensory systems

Question 20

What activities may be affected by apraxia?

Answer 20

Dressing, eating, drawing

Question 21

What is agnosia?

Answer 21

Inability to understand the significance of sensory stimuli

Question 22

What tools can be used to test global cognition?

Answer 22

▪️MMSE
▪️ACE-III

Question 23

What percentage of individuals with dementia experience behavioural and psychological symptoms?

Answer 23

98%

Question 24

What are behavioural and psychological symptoms in dementia associated with?

Answer 24

▪️Greater distress (patient and carer)
▪️Worsening cognition
▪️Worsening daily functioning
▪️Increased risk of falls
▪️Earlier institutionalisation and death

Question 25

What is the usual time course of Alzheimer's disease?

Answer 25

▪️Gradual onset ▪️Early memory impairment ▪️Progressive cognitive decline

Question 26

Which type of dementia may be observed with a stepwise deterioration of cognition?

Answer 26

Vascular dementia

Question 27

What risk factors may be indicative of vascular dementia?

Answer 27

Vascular risk factors such as diabetes, hypertension, history of heart attacks or stroke, atherosclerosis

Question 28

What type of dementia may more commonly present with neurogical signs such as facial nerve palsy?

Answer 28

Vascular dementia

Question 29

What criteria is used to diagnose Lewy body dementia?

Answer 29

The fourth census criteria - using core criteria and supportive biomarkers to diagnose probably and possible DLB

Question 30

What symptoms are useful for discrominating dementia with Lewy bodies from other dementia types?

Answer 30

▪️Cognitive fluctuations ▪️Visual hallucinations ▪️Spontaneous Parkinsonosm ▪️REM sleep behaviour disorder

Question 31

What are the two main variants of frontotemporal dementia?

Answer 31

Behaviour and language

Question 32

What is the characteristic sign of frontotemporal dementia?

Answer 32

Early decline in social/personal conduct

Question 33

In FTD, memory is typically preserved in the early stages. True or false.

Answer 33

True

Question 34

What are some of the key approaches to non-pharmacological management of dementia?

Answer 34

▪️Promotion of function and activity ▪️Behavioural therapy ▪️Social help and support groups ▪️Signposy to relevant services ▪️End of life care planning

Question 35

What are the two main drug types used for the pharmacological treatment of dementia?

Answer 35

▪️Acetylcholinesterase inhibitors ▪️NMDA antagonists

Question 36

What are pharmacological treatments used for in dementia?

Answer 36

Symptomatic relief - e.g. improve mental functioning, manage BPSDs (NOT disease modification)

Question 37

What is the main NMDA antagonist given in dementia?

Answer 37

Memantine

Question 38

For which two types of dementia are acetylcholinesterase inhibitors licensed for?

Answer 38

Alzheimer's and PDD

Question 39

For which type of dementia are acetylcholinesterase inhibitors contraindicated?

Answer 39

Frontotemporal dementia

Question 40

When would memantine usually be prescribed?

Answer 40

If the patient suffers side effects from acetylcholinesterase inhibitors or in the later stages of disease

Question 41

What is the first line of pharmacological treatment for most dementia?

Answer 41

Acetylcholinesterase inhibitors such as donepezil, rivastigmine, and galantamine

Question 42

What is the first line of treatment for behavioural and psychological symptoms of dementia?

Answer 42

Behavioural interventions

Question 43

What environmental factors are important to consider in the management of dementia?

Answer 43

▪️Physical environment ▪️Carer relationship and stress ▪️Level of stimulation, social activity and routine ▪️Quality of communication

Question 44

Why is safeguarding important for those with dementia?

Answer 44

They may have difficulties with: ▪️Preparing food and drink ▪️Self care ▪️Wandering ▪️Ability to deal with finances All of which leave them vulnerable to exploitation from others