Lecture 40: Dementia

Question 1

What is dementia?

Answer 1

Dementia is an umbrella term for a group of symptoms caused by many diseases:

• Requires MULTIPLE domain cognitive or behavioral impairment severe enough to affect DAILY function [Important to be aware of baselines]
• NOT explained by dilirium or mjr psychiatric disorders

i.e Memory, reasoning, visuospatial, language, behavior,

Young onset <65

Question 2

Can mild cognitive impairment be considered as dementia?

Answer 2

No as it does not affect daily function

Question 3

What are the major causes of dementia and presentation?

Answer 3

• Alzhiemers disease, 60%, INSIDIOUS, AMNESTIC
• Vascular Dementia, Suddent onset
• Dementia with lewy bodies, AD like presentation + LB
• Frontotemporal dementia, Behavioural or language presentation (Memory spared)

Question 4

How is dementia diagnosed in primary care?

Answer 4

• Comprehensive Pt history including collateral history
• Clinical and neurological exam
• Cognitive screen: i.e addenbrookes
• EXCLUDE DEPRESSION AND DILIRIUM
• Blood tests to exclude medical factors i.e B12 deficiency
• Neuroimaging

Question 5

What is the role of the specialist in dementia diagnosis?

Answer 5

Neurologist/geriatrician/psychologist/psychiatrist

• Neuroimaging, vascular disease etc
• Neuropsych assessment

Question 6

What is the role of genetics in dementia?

Answer 6

• Genetic testing for family history
• Few genes:
• > AD ~5% familial
• > FTD ~30% familial
• Some genes can increase risk of dementia
• > APOE in AD

Question 7

What can be done for dementia patients in terms of treatments?

Answer 7

Treatment is symptomatic not curative

Goal is to minimize functional decline, remain at home, maximize pt and caregiver quality time

1) Enhance cognition / delay decline (ACh esterase inhibitors, NMDA antagonism, Cognitive stimulation therapy)
2) Treat other symptoms i.e agitation, depression, parkinsonism
3) Treat cerebrovascular disease

Non-pharma management: Behavioral interventions, lifestyle advice, SLT/OT/PT

Question 8

What can be done for dementia patients in terms of management?

Answer 8

• Referral to dementia related organizations
• Advanced care planning, enduring power of attorney
• Driving safety assess

Question 9

Write some notes on maori with wareware:

Answer 9

• Younger at diagnosis
• Understanding of mate ware ware differs from western concepts
• Spiritual wellbeing (wairua) and whanau need to be considered

Question 10

What is the neuropathology of dementia?

Answer 10

• Affected region determines functional deficit
• Common feature is protein aggregates
• > Beta amyloid
• > Tau

etc

Question 11

What are the modifiable risk factors for dementia?

Answer 11

• Reckon 40% of dementia cases are potentially preventable
• > Obesity
• > Hearing loss
• > Smoking
• > Depression
• > Physical inactivity
• > Air pollution
• > Brain injury
• > Excessive alcohol consumption

Question 12

Describe the drugs used for enhancing cognition / delaying decline:

Answer 12

1. ACh inhibitors (NOT FOR FTD)
   - Autonomic neurotransmitter
   - Associated with side effects, GI, bradycardia
2. NMDA receptor antagonista (NOT FOR FTD)
   - Gultamate excitotoxicity is pathological
   - i.e memantine
3. Congitive stimulation therapy (FOR FTD AND ALL)