Dementia

Question 1

Define dementia

Answer 1

Someone can’t do the things they used to do because of new problems with memory and/or thinking (+ not better explained by another cause) - progressive decline

Question 2

What are the dementia-causing diseases and their prominent early clinical features?

Answer 2

Alzheimer’s Disease - memory problems
Vascular dementia - temporal association with stroke
Dementia with Lewy Bodies - hallucinations
Frontotemporal lobe dementia (language/behavioural)

Question 3

What are Lewy bodies?

Answer 3

Dense core, pale halo

Contains alpha-synuclein + ubiquitin

Question 4

What is the pathophysiology of dementia?

Answer 4

Abnormal accumulation of proteins - diff types, diff areas depending on neurodegenerative disease

with

abnormal loss of brain

• changes in brain pre-date symptoms by many years

Question 5

What other diagnoses can mimic dementia and should not be missed?

Answer 5

Structural - tumours, hydrocephalus, subdural haematoma
Metabolic - overtreated DM, thyroid disease
Infective - HIV/AIDS
Inflammatory - autoimmune encephalitis
Electrical - temporal lobe epilepsy

Question 6

What else can contribute to progressive cognitive impairment?

Answer 6

Other psychiatric conditions - delirium, depression, anxiety
Fibromyalgia, perimenopause
Drugs - anticholinergic burden
Sleep disturbance
Pain

Question 7

What is the approach to history-taking in suspected dementia?

Answer 7

Patient and collateral
PC - when were they last well, what has changed, concerns, what is a normal day
* think of cognitive domains: memory, executive function, visuospatial ability, personality + behaviour, language, neuropsychiatric,
- Functional impairment, safety

Social history - education, driving, social support

Question 8

What exams are done?

Answer 8

CV + respiratory systems
weight
focal neurological signs
extrapyramidal signs
primitive reflexes 

Mental state - appearance/behaviour/speech/mood/GDS/thought/perception/
insight
Cognitive assessment - MMSE, MoCa, ACE-III

Question 9

What is the approach to investigation in suspected dementia?

Answer 9

Rule out other causes

Identify dementia-causing disease

Question 10

What investigations are done?

Answer 10

Bloods

• FBP, ESR, U+E, LFTs, calcium, CRP, glucose
• TFT
• B12 + folate
• HbA1c

ECG
CT/MRI/DaT scan/FDG-PETCT