Dementia

Question 1

Kinds of dementia

Answer 1

1. Alzheimers dementia - 50-75%
2. Vascular dementia - 10-20%
3. Dementia with Lewy bodies - 10-15%
4. Frontotemporal dementia - 5-15%

Question 2

Biggest risk factor for dementia?

Answer 2

Age = Prevalence doubles every 5 yrs

Family history
Female gender
Head injury
Vascular disease
Low folate and B12
APoE E4 allele
Down Syndrome

Question 3

Definition of dementia

Answer 3

Evidence of significant cognitive decline in 1 or more cognitive decline

Cognitive decline interferes with ADLs

Not in context of delirium or other metal disorder

Question 4

MMSE and dementia

Answer 4

Score <24 suggestive of dementia or delirium

Not effective for frontal/executive function

Age, language and education dependent

Question 5

Alzheimer Dementia genetics

Answer 5

Early onset alzheimers dementia

<1% of alzheimers

Amyloid precursor protein
Presenilin 1
Presenilin 2

APoE E4 ??

Question 6

Vascular dementia definition

Answer 6

Cognitive decline within 3 months of a symptomatic stroke

Question 7

Vascular Dementia clinical features

Answer 7

Early deficits in attention, executive function and self monitoring

Early gait disturbance - apraxia

Question 8

Dementia with Lewy Bodies

Answer 8

Diagnosis:

• Fluctuating cognition, attention and alertness
• Recurrent visual hallucinations
• Spontaneous motor Parkinsonism

Rapid onset with progressive decline - 1-4yrs

Question 9

Frontotemporal dementia

Answer 9

Personality and social conduct impaired
Memory relatively preserved

60-70yrs
50% have family history
Association with MND - FTDP-17

Question 10

Neuropathology

Answer 10

AD: Amyloid plaques, tau tangles, lewy bodies

DLB: lewy bodies

FTD: 50% Tau and 50% TDP 43

Vascular dementia: Ischaemic changes

Question 11

Cholinesterase Inhibitors

Answer 11

Symptom controlling rather then disease modifying treatment

Donepezil, Rivastigmine, Galantamine

10-33% of patients have a discernible benefit:

• Retention of ADLs
• May improve adverse behaviours
• Slows cognitive decline approx. 1 yr

S/Es: Nausea, vomiting and diarrhoea, sleep disturbance, agitation and delirium, VAGOTONIC BRADYCARDIA

50% of patients have a severe adverse event

Question 12

Memantine

Answer 12

Neuroprotective NDMA antagonist

Occasional lazarus effects

Well tolerated

May can seizures

Question 13

Non-pharmacological Treatment

Answer 13

Care giver training

Cognitive training

Question 14

Management of behavioural disturbance

Answer 14

Pharm:

• Respiradone
• Olanzapine
• Quetiapine for LBD

Non-pharm:

• Music
• Reminiscence therapy
• Recorded voices
• Doll therapy

Question 15

Mild cognitive impairment

Answer 15

Between normal cognition and dementia

Normal function but impaired cognition

30% become AD yrly