Dementias

Question 1

What are the 5 A’s of Alzheimer’s

Answer 1

Agnosia
Amnesia
Aphasia
Apraxia
Associated symptoms  (Behavioural/Psychological symptoms of Dementia (BPSD)

Question 2

Criteria for diagnosis of dementia

Answer 2

irreversible cognitive impairment lasting >6 months

Question 3

Name some AChE-i drugs

Answer 3

Donepezil (Aricept)
Galantamine
Rivastigmine

Question 4

S/E of AChE-i drugs

Answer 4

Pro-cholinergic side effect profile:
N+V, diarrhoea
restlessness
aggression
muscle cramps

Question 5

Name some NMDA antagonists drugs and why they would be used

Answer 5

Memantine

AChE-i contraindicated / not tolerated / not effective

Question 6

Which investigations formulate a basic dementia screen?

Answer 6

Routine haematology - FBC, ferritin, vitamin B12, folate, TFTs, syphilis screen
Biochem - electrolytes, renal function, LFTs,
MSU
CT/MRI head
CXR/ECG where indicated

Question 7

Whats needed for diagnosis of vascular dementia?

Answer 7

Cognitive testing + CT/MRI brain imaging

Onset of dementia within 3 months following a recognised stroke

Question 8

3 subtypes of Fronto-Temporal Dementia (FTD)

Answer 8

Behavioural = change in personality / behaviour / interpersonal skills

Progressive-non-fluent-aphasia = loss of language skills

Semantic = loss of semantic memory

Question 9

Best mode of imaging in dementia?

Answer 9

MRI head best used to visualise cortical atrophy

Question 10

Management of FTD?

Answer 10

Treat the symptoms that are present
Some benefit with SSRIs
Psychosocial interventions

Do not use AChE-i as cholinergic systems not affected in FTD

Question 11

Characteristics of Lewy-Body Dementia

Answer 11

Fluctuating course
Spontaneous motor features of Parkinsonism
2/3 get visual hallucinations
syncope/collapse/falls

AD - sleep disorders, depressive episode (50%)

Question 12

What do DLB and PD share?

Answer 12

Same disease process:

In DLB - Lewy-Bodies deposited in cortical areas (primarily psych symptoms)

In PD - deposition occurs in basal ganglia (primarily motor symptoms)

Question 13

Management of DLB?

Answer 13

Tricky one:

Psych symptoms worsen with L-Dopa
Motor symptoms worsen with antipsychotics

AChE-i may help, + benzos etc
Psychosocial interventions crucial

Question 14

Management of BPSD in dementia?

Answer 14

Prescription of antipsychotics - Risperidone

If depression more prevalent consider Citalopram first line SSRI