Dementia

Question 1

define dementia

Answer 1

6 months or more of impaired:
memory
cognition
executive function
personality
all in clear consciousness

Question 2

what cognitive screening tools can be used in dementia and what are their cut of marks?

Answer 2

MMSE - 24/30
AMT - 6/10
CAPE test 8/12
clock drawing

Question 3

what are the different types of dementia?

Answer 3

alzheimers
vascular
lewy body
others e.g. CJD, AIDS

Question 4

what reversible causes must you rule out before diagnosing dementia?

Answer 4

chronic alcohol abuse
vitamin B12 or thiamine deficiency
hypothyroidism
normal pressure hydrocephalus
syphilis
frontal lobe tumour

Question 5

what cognitive functions are lost in dementia?

Answer 5

executive functions e.g problem solving, planning, processing info
visuo-spatial abilties e.g. writing, driving, finding directions
language vocab, understanding language, conversation, finding words

Question 6

what is apraxia?

Answer 6

inability to perform previously learned, purposeful movements despite normal coordination and strength e.g dressing self

Question 7

what is agnosia?

Answer 7

impaired recognition of sensory stimuli not attributed to sensory loss e.g. not recognising faces

Question 8

what are the non-cognitive symptoms in dementia?

Answer 8

disturbed:
perceptions - hallucinations
thought - delusions
behaviour - wandering, agression, apathy
emotion - depression

Question 9

how does alzheimers usually present?

Answer 9

memory loss - inability to recall new information

Question 10

what are the pathological features in alzhemiers?

Answer 10

global reduction of size of brain
widened sulci
enlarged ventricles
plaque and protein deposition

Question 11

what are the plaques found in alzheimers made of?

Answer 11

beta amyloid

Question 12

what are the proteins found in alzheimers?

Answer 12

tau proteins
form tangled clumps
usually stabilise healthy microtubules in the neuron

Question 13

in alzheimers, what specific areas of the brain is there neuronal decay?
what are these areas usually involved in?

Answer 13

entorhilal cortex in temporal lobe - memory and navigation
hippocampus - memory and navigation
parietal lobe association areas - reading, writing, problem solving

Question 14

how could you manage alzheimers disease?

Answer 14

AchEIs e.g. rivastigmine, galantamine, donepezil
Memantine is used in severe disease or if the above is not tolerated
psychosocial support
antidepressants

Question 15

what are the ADRs of AchEIs?

Answer 15

GI disturbance
increased salivation
drowsiness
worsening of EPS in parkinsons

Question 16

how is alzheimer’s disease staged?

Answer 16

mild
moderate
severe

Question 17

what are the features of mild alzheimers?

Answer 17

short term memory deficit

ADL not affected

Question 18

what are the features of moderate alzheimers?

Answer 18

significant memory loss
personality and behavioural changes
difficulty in orientation and language
ADL impaired

Question 19

what are the features of severe alzheimers?

Answer 19

dysphasia with disordered speech
agression/restlessness/wandering
psychosis
incontinence
global physical detrioration

Question 20

decribe the pathophysiology of vascular dementia. what could cause vescular dementia?

Answer 20

occlusion of blood flow to the brain causes neuronal death

e.g. arteriosclerosis, haemorrhage, embolus, vasculitis

Question 21

what would you check for on examination specifically in vascular dementia?

Answer 21

unilateral UMN deficit

focal neurological signs e.g. babinski

Question 22

what are the risk factors for vascular dementia?

Answer 22

hypertension
diabetes
high cholesterol
atherosclerosis
smoking
risk factors for stroke e.g. AF, prosthetic valve, family history, ethnicity

Question 23

what are lewy bodies?

Answer 23

abnormal protein aggregates that orm inside nerve cells

Question 24

how does lewy body dementia present?

Answer 24

fluctuating levels of cognitive impairment
memory loss
visual hallucinations
parkinsonism
impaired visuospatial skills
the latter two can lead to recurrent falls

Question 25

what investigations would you do in dementia?

Answer 25

FBC
ESR/CRP
U&E
Ca
LFT
glucose
TFT
B12 and thiamine
syphilis, HIV
MRI better than CT

Question 26

what are the areas tested in an MMSE?

Answer 26

orientation
registration
attention
recall
language and copying

Question 27

how do you test for orientation in the MMSE?

Answer 27

orientation in time:
year, season, month, date, time (5)
orientation in place:
country, county, city, place, floor/ward (5)

Question 28

how do you test for registration in the MMSE?

Answer 28

apple, table, penny

repeat until correct (3)

Question 29

how do you test for attention in the MMSE?

Answer 29

serial 7s
or spell WORLD backwards
(5)

Question 30

how to do you test for recall in the MMSE?

Answer 30

recall apple table penny

3

Question 31

how do you test for language and copying in the MMSE?

Answer 31

ask to name two objects e.g. pen, watch (2)
no ifs, ands, buts (1)
take piece of paper, fold it in half and put it on the floor (3)
close your eyes (read) (1)
write a sentence (1)
copy intersecting pentagons (1)