Dementia

Question 1

Define dementia

Answer 1

Syndrome characterised by an appreciable deterioration in cognition -> behavioural
problems and impairment of ADLs

Question 2

What are the causes/risk factors of dementia?

Answer 2

Endocrine/metabolic
• Thyroid disease
• Wilson’s disease

Infection
• Neurosyphilis
• Creutzfeldt-Jakob disease

Inflammation
• SLE
• Sarcoidosis

Toxic
• Alcohol
• Heavy metals e.g. arsenic

Traumatic

Vascular dementia
• Infarction
• Haemorrhage
• Leukoaraiosis (axonal
and myelin loss)

Risk Factors
• Increasing age
• Family history (Alzheimer’s)
• Cerebrovascular disease
• Hypertension and  smoking
(vascular dementia)

Question 3

What are the signs and symptoms of dementia?

Answer 3

Alzheimer's:
• Nominal dysphasia
• Disorientation
• Misplacing items/getting lost
• Failure to recognise familiar faces
• language deficits

Vascular:
• Poor attention
• Retrieval memory deficit
• Focal neurological signs
• Signs of vascular disease

Lewy body:
• Repeated falls and syncope
• Delusions
• Attention and visuospatial abnormalities
• Increased tone
• Shuffling gait
• Fluctuating cognition

Frontotemporal:
• Loss of language fluency/comprehension
• Memory impairment
• Apraxia
• Disinhibition
• Socially inappropriate behaviour
• Poor judgement
• Apathy

Question 4

What investigations are carried out for dementia?

Answer 4

• FBC - to rule out anaemia.
• U&Es - hypo- or hypernatraemia, hypo- or hypercalcaemia, hypo- or hyperglycaemia should be sought to rule out metabolic causes of dementia.
• LFTs - to exclude encephalopathy as a cause of symptoms.
• ESR/ CRP - to exclude inflammatory conditions.
• TFTs - rule out hyperthyroid- or hypothyroid-associated dementia.
• Haematinics - esecially folate and B12 deficiency.
• Antibody Serology - ANA, ANCA and other auto-antibodies.
• LP - in subacute onset AD, to exclude prion disease and encephalitis.
• Genetic Testing - offered in early onset dementia or when a strong family history is present.
- PSEN Mutations may be detected.
• Psychometric Testing - useful for defining domains of impairment. May be helpful for distinguishing depressive pseudo-dementia.
• EEG - not diagnostic, but may be useful to exclude non-convulsive status epilepticus as a cause.
• CT - may show brain atrophy consistent with AD.
- Useful in excluding tumours, normal pressure hydrocephalus, subdural haematoma, or vascular disease.
• MRI - generalised atrophy with medial temporal lobe and later parietal predominance.
- Increased sensitivity in identifying lesions when compared with CT findings