Dementia

Question 1

Definition of cognitive impairment

Answer 1

Impairment in higher cortical functions such as memory, thinking, language, perception, or awareness

Question 2

Definition of dementia

Answer 2

ICD 10
1. Cognitive impairment
- both memory and thinking
2. Impairs ADLs
- processing incoming information
3. Clear consciousness
4. Present for >6 mo

Question 3

Global and UK dementia prevalence

Answer 3

57 million worldwide, 10 million new cases/year; 885,000 in UK (2019), projected 1.6 million by 2040

Question 4

Main causes of dementia

Answer 4

• Alzheimer’s,
• vascular dementia,
• frontotemporal dementia,
• Lewy body dementia,
• alcohol-related,
• Huntington’s

Question 5

Pathology of Alzheimer’s

Answer 5

• Brain atrophy,
• amyloid plaques,
• reduced ACh,
• neuroinflammation

Question 6

Features of vascular dementia

Answer 6

Caused by vascular damage, often due to hypertension or strokes, step wise decline after vascular events

Question 7

Dementia with Lewy bodies features

Answer 7

Parkinsonism, cognitive decline, visual hallucinations, delusions, REM sleep disturbance, fluctuating consciousness

Question 8

Frontotemporal dementia features

Answer 8

Younger onset (40–60), affects behaviour, speech, language, often inherited

Question 9

Modifiable dementia risk factors

Answer 9

Exercise, healthy weight, mental stimulation, BP/glucose control, smoking/alcohol, hypertension

Question 10

Early dementia presentation

Answer 10

Mild memory issues, mood/behaviour change, minimal ADL impact

Question 11

Mid-stage dementia features

Answer 11

Worsening memory and behaviour, increasing disability, poor insight

Question 12

Late-stage dementia features

Answer 12

Severe memory loss, major cognitive and behavioural issues, high dependency

Question 13

Behavioural and Psychological Symptoms of Dementia (BPSD) categories

Answer 13

Affective (e.g. depression), Apathetic (lack of emotion), Psychotic (hallucinations), Hyperactive (agitation, aggression)

Question 14

BPSD management

Answer 14

Identify triggers, ABC charts, behavioural approaches, SSRIs, cautious antipsychotic use (e.g. risperidone), benzodiazepines when in crisis (avoid haloperidol in Parkinson’s)

Question 15

Differential diagnoses for dementia

Answer 15

1. Delirium
2. Functional
   - Depression/anxiety
   - Catatonia/schizophrenia
3. Substance misuse
4. Menopause
5. Normal pressure hydrocephalus
6. Sensory deprivation
   - loss of hearing/seeing
   - NB posterior cortical atrophy

Question 16

Common cognitive screening tools

Answer 16

AMTS, MMSE, 6CIT, GP-Cog, ACE-III

Question 17

Domains tested in ACE-III

Answer 17

Attention, memory, language, visuospatial skills, verbal fluency

Question 18

Blood tests for dementia workup

Answer 18

FBC, U&E, LFTs, CRP, TFT, calcium, HbA1c, B12, folate

Question 19

Imaging in dementia

Answer 19

MRI brain to assess vascular changes and exclude other pathology

Question 20

Other dementia investigations

Answer 20

Urine MCS, CXR to rule out infection or systemic cause (Cancer)

Question 21

Medical management of Alzheimer’s

Answer 21

AChE inhibitors (donepezil), NMDA antagonists (memantine)

Question 22

Planning ahead in dementia

Answer 22

LPA, advance directives, future care plans, ReSPECT forms

Question 23

Vascular dementia mx

Answer 23

1. Lifestyle
2. Athersclerosis
   - Aspirin
   - Clopidogrel
3. Cardioembolic (AF)
   - Warfarin
   - DOAC
4. HTN/DM/Cholesterol control