What are the types of dementia?
- Alzeimer’s
- Vascular
- Lewy Body
- Parkinson’s
- Frontotemporal
- Creutzfeldt-Jakob disease (CJD)/ prion disease
- Alcohol related
What are the symptoms of Alzheimer’s?
- Short term memory loss
- Dysphasia - speaking problems
- Dyspraxia - movement problems
- Behavioural changes, eg wandering
- Psychotic symptoms
- Apathy
What are the investigations for dementia generally?
- History/ exam
- Cognitive testing - Mini- ACE/ ACE in Dementia. For delirium 4AT, AT 10
- Bloods → norm + B12/ folate, ESR, antinuclear antibody (ANA), syphilis, and HIV.
- Brain imaging → CT/ MRI
What is the management for Alzheimer’s?
- cholinesterase inhibitors, eg donepezil, rivastigmine, and galantamine
◦ mild to moderate disease
◦ improve cognitive and behavioural symptoms
◦ increase acetylcholine availability. - memantine:
◦ moderate to severe disease
◦ N-methyl-d-aspartate (NMDA) glutamate receptor antagonist
What are the symptoms of vascular dementia?
- Gait disturbance
- Personality change
- Labile mood
- Urinary symptoms
- Insight preserved
What are the management of vascular dementia?
modify cerebral risk factors (eg smoking)
What are the symptoms of Lewy body?
- Sleep disorders
- Delirium + memory problems
- Visual (people + animals) + auditory hallucinations
- Parkinsonism
- Fluctuating dementia (periods of dementia then delirium)
- Autonomic instability
What is the management of Lewy body?
- cholinesterase inhibitors
- avoid anti-psychotics as can precipitate parkinsonian symptoms
What are the symptoms of Parkinson’s?
- Classical triad of features: bradykinesia, tremor and cogwheel
- Motor symptoms
- Parkinson’s dementia (after having Parkinson’s for a couple of years)
What are the clinical features of Parkinson’s?
- bradykinesia → slow hand movements + shuffling gait
- cogwheel → Stiff joints with a tremor
- Resting tremor → ‘pill-rolling’, i.e. in the thumb and index finger. Improves with voluntary movements
What is the management of Parkison’s?
- Levodopa (for motor symptoms)
- Dopamine agonists e.g. bromocriptine (given if motor symptoms don;t effect QoL)
- MAO-B inhibitors e.g. selegiline (given if motor symptoms don;t effect QoL)
What are the symptoms of Frontotemporal dementia?
- Stereotyped behaviours
- Personality change
- Loss of insight
- Expressive dysphasia
- Preserved memory
- Primitive reflexes
What is the management of Frontotemporal dementia?
- no specific treatment
- psychotropic drugs used with caution for depression and psychotic symptoms
What are the symptoms of Creutzfeldt-Jakob disease (CJD)?
- dementia (rapid onset)
- myoclonus
What are the symptoms of Normal pressure hydrocephalus?
- Apathy
- Inattention
- Urinary incontinence
- Gait apraxia
This suddenly happens
What is the management of Normal pressure hydrocephalus?
shunting
Which type (s) of dementias progress in a slow decline over time?
- Alzheimer’s
- Frontotemporal
- Parkinson’s
Which type (s) of dementias progress in a rapid decline over time?
- Lewy Body
- Creutzfeldt-Jakob disease (CJD)
Which type (s) of dementias progress in a stepwise decline over time?
Vascular
