Dementia

Question 1

What is the definition of dementia?

Answer 1

ICD-10: Chronic/progressive syndrome due to disease of the brain. Disturbance of multiple higher cortical functions. Consciousness not clouded. Accompanied by deterioration in emotional control, social behaviour or motivation. Minimum of 6 months

Question 2

How common is dementia?

Answer 2

Common

Question 3

What is the pathophysiology of dementia?

Answer 3

• Many different types: Alzheimers, Vascular, Lewy body, Huntingtons, Parkinsons Disease
• Categorised into mild, moderate and severe
• Alzheimers: due to deposition of insoluble beta amyloid plaques in the cortex, hippocampus or amygdala. Or Tau in neurofibrillary tangles

Question 4

What are the risk factors/aetiology of dementia?

Answer 4

• Age
• Alcohol
• Vitamin B12/folate deficiency
• Hypothyroidism
• Subdural haematoma
• Genetic
• Family history

Question 5

What are the signs/symptoms of dementia?

Answer 5

• First concerns often by family
• Decline in memory
• Decline in cognitive abilities – judgement, thinking, planning, organisation
• Decline in emotional control/motivation
• Change in social behaviour
• Irritability
• Hallucinations/delusions
• Apathy
• Aphasia/agnosia (cannot recognise things)/apraxia (difficulty with movements)
• Dysphagia
• Neurological symptoms: seizures, focal deficits ect.
• Wandering/getting loss
• Poor self care

Question 6

What diseases present similarly to dementia?

Answer 6

• Pseudo-dementia: depression with cognitive impairment
• Depression
• Psychosis
• Delirium

Question 7

What investigations are conducted for suspected dementia?

Answer 7

• History is key! – ask family
• Mental state examination
• Cognition assessment
• Bloods – FBC, B12/folate, ESR, U&E, thyroid, liver, calcium, sugar, lipids etc.
• ECG
• CXR
• CT/MRI

Question 8

How will dementia affect the patients ability to drive?

Answer 8

Will lose the ability to drive at some point

Question 9

What are the pharmacological treatments for dementia?

Answer 9

• Ach inhibitors – Alzheimers dementia
• Aspirin – vascular dementia
• Antioxidents
• Hormone replacement
• Antipsychotics

Question 10

What are the non pharmacological treatments for dementia?

Answer 10

• Orientation
• Reminiscence therapy
• Memory aids