Dementia

Question 1

What are the top 3 types of dementia in the UK?

Answer 1

1. Alzheimers Dementia
2. Vascular dementia
3. Lewy Body Dementia

Question 2

What do we use to point to a diagnosis of dementia?

Answer 2

Mini-mental State Examination.

A score of <=24/30 suggests dementia.

Question 3

What should be done in primary care before diagnosing dementia?

Answer 3

Blood tests to exclude reversible causes:

FBC, U&Es, LFTs, Calcium, Glucose, TFTs, Vitamin B12 and folate levels.

Question 4

In secondary care what investigation is done?

Answer 4

CT Scan to exclude reversible conditions and provide prognosis and potential causes..

(Reversible causes: Subdural haematomas, normal pressure hydrocephalus)

Question 5

What is the characteristic pathological feature of Lewy Body Dementia?

Answer 5

alpha-synuclein cytoplasmic inclusions (Lewy Bodies) in the substantia nigra, paralimbic and neocortical areas.

Question 6

How can you tell the difference between Lewy Body Dementia and Parkinson’s disease with dementia?

Answer 6

In Lewy Body Dementia, they will often present with dementia first along with hallucinations. The Parkinson’s disease will come second.

In Parkinson’s Disease, the patient will notice the movement problems first and then the dementia.

Question 7

What particular drugs should be avoided in Lewy Body Dementia?

Answer 7

Antipsychotics.

Questions often have a patient that will usually deteriorate following the introduction of an antipsychotic agent.

Question 8

What would make you think someone has delerium instead of dementia?

Answer 8

• Impairment of consciousness
• Fluctuation of symptoms: worse at night, periods of normality
• Abnormal perception (e.g. illusions and hallucinations)
• Agitation, fear
• Delusions

Question 9

What sort of pathological changes are seen in Alzheimer’s Disease?

Answer 9

• Macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus
• Microscopic: cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
• Biochemical: there is a deficit of acetylecholine from damage to an ascending forebrain projection

Question 10

How is Alzherimer’s Disease managed?

Answer 10

1. Mild to moderate Alzheimer’s disease - give Acetylcholinesterase inhibitors.
   
   • Donepezil, Galantamine and Rivastigmine.
2. Memantine (a NMDA receptor antagonist) for people with:
   
   • Moderate Alzheimer’s disease who are intolerant of or have a contraindication to AChE inhibitors OR severe Alzheimer’s disease.

Question 11

5% of Alzheimer’s disease cases are inherited in what manner?

Answer 11

Autosomal dominant

Question 12

What MMSE score is the cut off for diagnosing dementia?

Answer 12

24

Question 13

If an MMSE score is 25-30 (out of 30) what is this considered?

Answer 13

Normal

Question 14

If an MMSE score is 21-24 (out of 30) what is this considered?

Answer 14

Mild

Question 15

If an MMSE score is 10-20 (out of 30) what is this considered?

Answer 15

Moderate

Give AChE Inhibitors: Donepazil, Rivastigmine or galantamine.

Only give Memantine if intolerant to the AChEI or if contraindicated.

Question 16

If an MMSE score is <10 (out of 30) what is this considered?

Answer 16

Severe

Give Memantine.

Question 17

Which one of the following could be a contraindication for Donepezil?

• History of depression
• Sick sinus syndrome
• Concurrent simvastatin therapy
• Concurrent citalopram therapy
• Ischaemic heart disease

Answer 17

Sick sinus syndrome

• Donepezil may cause bradycardia and atrioventricular node block.

Question 18

What are some rarer causes of dementia?

Answer 18

• Huntington’s
• CJD
• Pick’s disease (atrophy of frontal and temporal lobes)
• HIV (50% of AIDS patients)