Dementia

Question 1

List 3 diagnostic criteria for dementia

Answer 1

History of global cognitive decline lasting months-years - with respect to previous cognition
Decline in level of function
No evidence of reversible cause

Question 2

Give 3 examples of cognitive assessment tools

Answer 2

ACE-3
MoCA
FAB

Question 3

Who carries out a cognitive performance test?

Answer 3

Occupational Therapy

Question 4

What is a cognitive performance test?

Answer 4

Observing the patient carrying out daily living activities e.g. dressing, washing, shopping etc
Estimates their ability to live at home based on their cognition

Question 5

What are the key features of Alzheimer’s Disease?

Answer 5

Memory Loss
Dysphasia
Dyspraxia
Agnosia

Question 6

What is the definition of dementia?

Answer 6

A syndrome of irreversible progressive and global intellectual deterioration without the impairment of consciousness

Question 7

What is the incidence of dementia in >65y/o

Answer 7

6%

Question 8

List some reversible causes of cognitive impairment:

Answer 8

Alcohol
Medication
Brain lesions
Depression
endocrine disorders 
Delirium

Question 9

What scores would suggest mild cognitive impairment in ACE-III and MoCA tests?

Answer 9

80-90 ACE-III

24-26 MoCA

Question 10

How often should you repeat cognitive assessments if patients show mild impairment?

Answer 10

Yearly

Question 11

What are the main features of Alzheimer’s disease?

Answer 11

Memory loss (short term)
Dysphasia
Dyspraxia
Agnosia

Question 12

What might be seen on a CT of a patient with Alzheimer’s?

Answer 12

Normal 
or
Medial temporal lobe atrophy 
or
Temporoparietal Atrophy

Question 13

What class of medications can be used in the treatment of Alzheimer’s disease?

Answer 13

Cholinesterase Inhibitors

Question 14

Give some examples of cholinesterase inhibitors:

Answer 14

Donepezil
Rivastigmine
Galantamine

Question 15

What is the main role of cholinesterase inhibitors?

Answer 15

Slow cognitive decline

Question 16

What must be checked before prescribing or changing the dose of cholinesterase inhibitors?

Answer 16

Pulse

Question 17

When are cholinesterase inhibitors contra-indicated?

Answer 17

Active peptic ulcer disease

Severe asthma / COPD

Question 18

Other than cholinesterase inhibitors, what is another drug licensed for Alzheimer’s disease?

Answer 18

Memantine

Question 19

When should you start memantine?

Answer 19

Moderate dementia

Question 20

What symptoms are much more common in Vascular Dementia than Alzheimer’s?

Answer 20

Dysphasia
Dyscalculia
Frontal lobe symptoms
Affective symptoms

Question 21

What will be seen on an MRI/CT of a patient’s brain who has vascular dementia?

Answer 21

Moderate - severe small vessel disease

Multiple lacunar infarcts

Question 22

What are the three main syndromes of frontotemporal dementia?

Answer 22

• Behavioral variant
• Primary progressive aphasia
• Semantic dementia

Question 23

Give the symptoms of behavioral variant syndrome associated with frontotemporal dementia?

Answer 23

Behavioral changes
Executive dysfunction inhibition
Impulsivity 
Loss of social skills
Apathy
Obsessions
Change in diet

Question 24

Explain the primary progressive aphasia seen in frontotemporal dementia:

Answer 24

Effortful non-fluent speech
Speech sound/articulatry errors
Lack of grammar
Lack of words

Question 25

Explain what is meant by semantic dementia seen in frontotemporal dementia:

Answer 25

Impaired understanding of meaning of words Fluent but empty speech Difficulty retrieving names

Question 26

How many patients with Parkinson's will develop Parkinson's dementia?

Answer 26

80% (by 15-20 years)

Question 27

How long must a patient have had Parkinson's for it to be considered Parkinson's dementia?

Answer 27

At least 1 year

Question 28

What is the typical pattern of dementia in Lewy Body Dementia (DLB)

Answer 28

Early involvement of reduced attention, executive function and visuospatial skills

Question 29

List the criteria that a patient with DLB must have at least 2 of to meet the diagnosis:

Answer 29

``` Visual hallucinations Fluctuation cognition REM sleep behavior disorder Parkinsonism (at least 1 year) Positive DAT scan ```

Question 30

What is a DAT scan?

Answer 30

Dopamine Active Transporter Scan | Diagnostic for lewy body and Parkinson's dementia

Question 31

What type of scan is most useful for frontotemporal dementia?

Answer 31

SPECT scan

Question 32

What type of scan is most useful if the patient is young, showing rapid progression or has atypical features?

Answer 32

MRI

Question 33

Other than Alzheimer's what other forms of dementia can be treated with cholinesterase inhibitors?

Answer 33

Parkinson's | Lewy Body

Question 34

What are some non-cognitive psychological symptoms of Dementia's?

Answer 34

``` Irritability Aggression Hallucinations Wondering Mood disturbances ```

Question 35

In dementia, is neuronal involvement asymmetrical or symmetrical?

Answer 35

Symmetrical degeneration This is what differentiates it from MS etc

Question 36

What is another name for frontotemporal dementia?

Answer 36

Picks disease

Question 37

What macroscopic pathological changes are seen in Alzheimer's?

Answer 37

``` Decreased size & weight of brain Atrophy of lobes Widening of sulci Narrowing of gyri Compensatory dilation of ventricles ```

Question 38

What lobes of the brain are typically spared in Alzheimer's?

Answer 38

Occipital Cerebellum Brainstem

Question 39

What 2 microscopic abnormalities are associated with Alzheimer's?

Answer 39

Neurofibrillary tangles | Neuritic plaques

Question 40

Why are people with Down's syndrome more likely to develop Alzheimer's?

Answer 40

Amyloid precursor protein (APP) is coded for on chromosome 21 APP is linked to Alzheimer's disease - creates neuritic plaques

Question 41

What test is positive for amyloid?

Answer 41

Congo red staining