Dementia

Question 1

Define Dementia?

Answer 1

• Alert Patient
• Progressive impairment of multiple cognitive domains
• Leads to a loss of acquired skills
• Causing social and work impairment

Question 2

We split dementia into early (<65) and late (>65) onset, what causes early onset dementia?

Answer 2

1/3rd alzheimer’s

1/3rd are vascular or frontotemporal

1/3rd are other causes

• Alcohol
• Genetic Conditions e.g. huntington’s Chorea
• Infection e.g. (HIV/CJD)
• CNS inflammation (e.g. MS)

Question 3

What causes late onset dementia?

Answer 3

• Alzheimer’s (>50%)
• Vascular
• Lewy Body

Question 4

List some treatable causes of dementia like cognitive decline?

Answer 4

• Advance B12 deficiency
• Thyroid Disease
• Infection e.g. HIV

Question 5

List some conditions that can mimic dementia?

Answer 5

• Hydrocephalus
  & Tumours (Slowly raised ICP)
• Depression

Question 6

How do you take a dementia history?

Answer 6

• From an independant witness

you want to know about:

• Family history
• Type of deficits
• How it progresses (E.g. if its very rapid it may be an infection like CJD)

Question 7

What would you look for on an examination of a dementia patient when trying to determine the cause?

Answer 7

• Chorea (e.g. huntington’s)
• Parkinsonism (Lewy Body)
• Myoclonus (CJD)

Question 8

What investigations can be done to determine the cause of dementia?

Answer 8

Screening tests e.g. MMSE or Montreal Cognitive Assessment (MOCA)

• Blood Tests
• CT/MRI
• LP
• EEG
• Functional imaging
• Genetic testing

Question 9

Describe the presentation of dementia?

Answer 9

Progressive loss of MULTIPLE cognitive domains

• Memory
• Attention
• Language
• Visuospatial problems
• Emotion
• Behavioural changes
• Apraxia
• Agnosia

Often best to see how their function at work has changed, this may show signs of cognitive impairment before they look very abnormal, particularly in people used to functioning at an “above Average” level.

Question 10

How can we treat symptoms of Dementia?

Answer 10

• Information
• Occupational Therapy
• Social work & respite care
• Refer to voluntary organisations

Also some medical treatments for aggressive behaviour (antipsychotics), insomnia or depresssion

Question 11

How can we treat the causes of dementia?

Answer 11

• Frontotemporal dementia has no treatment
• Vascular, not even treating vascular risk factors slows it down

Alzheimer’s and lewy body dementia can be treated symptomatically with cholinesterase inhibitors to improve the function of the remaining cholinergic neurons but wont delay neuronal loss
Also with NMDA antagonist for Alzheimers

Question 12

How does Alzheimer’s specifically present?

Answer 12

1/2 of late onset and 1/3 of early onset.

It causes Temporal/parietal Dementia:

• Early memory disturbances
• Language issues
• Visuospatial problems
• Tend to preserve personality for a long time

Question 13

How does frontotemporal dementia present spefically?

Answer 13

~15% of early onset dementias

• Early personality changes
• Eating habit changes
• Language problems (Dysphasia/Dysarthia)
• Tend to preserve memory and visuospatial quite well

(Contrast to alzheimer’s where personality is preserved and memory/visuospatial goes early)