Dementia: overview and diagnosis

Question 1

is dementia a normal part of ageing

Answer 1

negatory

Question 2

define dementia

Answer 2

global impairment of cognition, social and occupational functioning

Question 3

most common cause of dementia

Answer 3

Alzheimer’s disease

Question 4

first and most predominant symptom

Answer 4

memory loss

Question 5

what is MCI

Answer 5

Mild Cognitive Impairment
when there is evidence of cognitive impairment on cognitive testing that does not affect activities of daily living

Question 6

do people with MCI develop dementia

Answer 6

10-15% will develop dementia compared to 1-2% of older population

Question 7

can MCI go away

Answer 7

some will improve, some will remain static

Question 8

types of memory loss in MCI

Answer 8

amnestic: memory
non-amnestic: language and attention

Question 9

diagnosis of alzheimers and related dementias is based on

Answer 9

clinical diagnosis +
investigation to exclude other causes of cognitive impairment

Question 10

main clues to dementia

Answer 10

• memory loss
• confusion
• repetitiveness
• getting lost in familiar places
• personality change: irritability, hoarding, indifference, ritualistic behaviours
• apathy and withdrawal
• apraxia
• agnosia
• impaired language skills: limited vocabulary
• loss of ability to perform daily tasks

Question 11

other causes of memory loss to exclude

Answer 11

• delirium
• psych: depression, anxiety
• alcohol/substance abuse
• medication side effects
• neurological: tumour, chronic subdural
• normal pressure hydrocephalus
• B12/folate deficiency, hypothyroid, hypercalcaemia
• infections: neurosyphilis, HIV
• collagen vascular disease, cerebral vasculitis

Question 12

ADLs

Answer 12

activities of daily living
basic self care
eg. bathing, dressing and grooming, toileting, ambulation, feeding

Question 13

IADLs

Answer 13

instrumental activities of daily living
more challenging self care tasks
eg. home cleaning, managing finances, shopping and meal prep, managing medications, using technology and telephones, managing transportation

Question 14

what is normal with ageing

Answer 14

slower learning, mental processing and minor forgetfulness
subjective memory complaints (SMC)
‘benign forgetfullness’

Question 15

how is MCI different from normal ageing

Answer 15

cognitive testing reveals cognitive deterioration

Question 16

why is MCI different to dementia

Answer 16

not severe enough memory loss to interfere with daily activities

Question 17

limitations of cognitive screening tests

Answer 17

• depends on patient age, literacy, and education level
• intellectual and physical disability
• depression and anxiety can impair concentration and affect results
• language and cultural biases
• detect cognitive impairment from any cause, not just dementia
• not a definitive diagnosis
• normal score cannot exclude cognitive decline

Question 18

when to use neuropsychological testing

Answer 18

• when diagnosis is uncertain
• atypical features
• younger onset
• possibility of depression
• can establish baseline for future monitoring
• progression is too rapid

Question 19

brain of people with alzheimers dementia on CT/MRI

Answer 19

shrink as the disease progresses
shrinkage in specific areas such as the hippocampus can be early sign

Question 20

brain of people with fronto-temporal dementia on CT and MRI

Answer 20

reduced volume in frontal or temporal lobes

Question 21

what is functional brain imaging

Answer 21

shows how well cells in various brain regions are working

Question 22

examples of functional brain imaging

Answer 22

PET (glucose, amyloid, dopamine)
fMRI
SPECT - single photon emission CT