GP ILA 4: Living with a stranger

Question 1

Blood tests for reversible causes of dementia

Any other tests?

Answer 1

FBC, U and Es, TFTs, B12 and folate, glucose, LFTs

Urine test

Question 2

Screening tools for dementia

a) Most common in GP?
b) Most common in hospitals?
c) In memory clinics

Answer 2

6-CIT (6-item cognitive impairment test)
AMT (Abbreviated mental test, /10)
MMSE (Mine mental state examination/30)
Addenbrookes (ACE-III)

Question 3

3 groups of symptoms in dementia

Answer 3

• Cognitive: Amnesia (memory), Aphasia (language), Agnosia (recognition), Apraxia (planning)
• Behavioural/psychiatric - depression, apathy, agitation, lability, disinhibition, hallucinations
• Functional (ADLs) - immobility, incontinence, gait issues

Question 4

Causes of irreversible dementia

Answer 4

Idiopathic - protein inclusions, degeneration
Genetics
CVD

Question 5

Depression (pseudodementia) vs dementia

- what test should you perform in an elderly person with suspected pseudodementia?

Answer 5

Depression: Greater insight, poor concentration, onset more sudden, depression patients more likely to say “I don’t know” whereas dementia patients more likely to try and fail in MMSE, more short-term versus global in dementia.
Perform Geriatric Depression Scale

Question 6

Genetics in AD

a) 3 in early-onset (one relevant in Downs)
b) 1 in late-onset

Answer 6

a) Presenilin 1 (Ch14), Presenilin 2 (Ch1), Amyloid precursor protein (APP) - Ch21
b) APOE4

Question 7

Pathophysiology of AD

a) Histology
b) Imaging

Answer 7

a) Beta-amyloid, Neurofibrillary tangles (composed of Tau protein)
b) Cortical atrophy (hippocampal, generalised), enlarged ventricles

Question 8

Imaging

SPECT and DAT

Answer 8

Explain

Question 9

MDT in dementia

• Specific to clinical need
• Nurses specific to dementia?

Answer 9

GP, geriatrician, neurologists (e.g. PD, LBD), psychologists, social care, PT/OT, podiatrist, optometrist, audiologist, SALT, community nurses (e.g. district, mental health, TVN)
Admiral nurses (not available everywhere), dementia friends

Question 10

Non-specific care needs for dementia patients

Answer 10

Meals on wheels
Laundry
OT - rails, tap turners, stairlift, walk-in shower

Question 11

Specific care needs for dementia patients

Answer 11

District nurse - dressings,
Podiatrist/chiropodist
Admiral nurse - support the carers of people withe dementia
Social prescribing

Question 12

Is tube feeding/parenteral nutrition medical care or basic care?

Answer 12

Medical