Dementia

Question 1

What is dementia

Answer 1

Syndrome due to disease of the brain

Chronic or progressive nature

Disturbance of multiple higher cortical functions

Consciousness is not clouded

Accompanied by deterioration in emotional control, social behavior or motivation

Question 2

Epidemiology of dementia

Answer 2

1mill people in the UK will have dementia by 2025

2mill people in the UK will have dementia by 2050

35% of patients over 65

26k pounds for 1 patient

UK 26.3bn pounds per year

Question 3

Causes of dementia

Answer 3

Most important

Alzheimer’s: the most common (>50%)

Vascular

Picks disease

CJD

Huntington’s Disease

HIV

Parkinson’s Disease

Alcohol…and other drugs

Question 4

Differential diagnosis of dementia

Answer 4

Neurodegenerative Dementia

Delirium

Depression: pseudo-dementia, co-morbid in 20% of dementias

Psychosis

Question 5

What is pseudo-dementia

Answer 5

Depression presenting with cognitive impairment

Careful history
“Don’t know” answers

Complain about their memory difficulties

Beware:
Dementia and depression together
Depression can affect cognitive function e.g. slowing, poor concentration etc.

Question 6

Presentation of dementia

Answer 6

Usually in Primary Care

Often relatives have first concerns

Precipitating event e.g. wandering

Insidious memory loss

Poor self care

Others…
falls, getting lost, phone calls, missed appointments, accidents, worry about memory, repeating questions, misrecognition, not coping after death of spouse etc.

Question 7

Dementia assessment

Answer 7

History

Informant History - importance

Mental state

Cognitive Assessment screens vs. formal

Physical

Investigations

Question 8

Mental state examination

Answer 8

Check geeky medics

Question 9

Investigations for dementia

Answer 9

Physical examination

Blood tests
haematology (FBC, B12/ folate, PV/ESR)
biochemistry (renal, thyroid, liver, calcium, sugar)
Others (lipids, syphilis serology, etc.)

CT, MRI, ECG, MSU etc.

Collateral history from everyone

Question 10

Biological management of dementia

Answer 10

underlying causes

concurrent illness & contributing factors

e.g. depression, hearing loss, stop non-essential drugs that may interfere with cognition

disabilities e.g. hearing, vision

behavioural problems

Alzheimers - Acetyl cholinesterase inhibitors

Vascular dementia - Aspirin

Question 11

Psychological treatment of dementia

Answer 11

Reality orientation

Reminiscence therapy

Memory aids (notes, labels, dosettes or telecare)

Question 12

Social treatment of dementia

Answer 12

Environment

Safety DRIVING, medication, fires, cooking

Support homecare day centres

Financial

Question 13

Managing cares of demented patients

Answer 13

Support family

Education

Advice on communication

Self help groups

Financial and legal help

Practical support Social Services etc.