Dementia Types

Front 1

Define dementia

Back 1

Acquired
Global
Impairment of intellect, memory and personality
WITHOUT disturbance of consciousness

Front 2

Why are non-cognitive features of dementia important?

Back 2

1. Cause distress to carers leading to institutionalization
2. Amenable to Rx

Front 3

Commonest presenting features of AD?

Back 3

Memory disturbance
Disorientation

Front 4

Name 2 types of disorientation

Back 4

Spacial
Temporal

Front 5

3 main features characteristics of personalities of people with establised dementia

Back 5

Reduction of interests (shrinking of the milieu)
Rigid stereotyped routine (organic ordeliness)
Explosions of emotion when patient taxed beyond ability (catastrophic reaction)

Front 6

Think of the five A's of dementia...

Back 6

Amnesia
Aphasia
Apraxia
Agnosia
Associated features (psychiatric sx, behaviour)

Front 7

Initially, amnesia in AD is with respect to long-term memory.
T/F?

Back 7

F - relation to recent events

Front 8

Memory disturbances include poor recall and impaired recognition.
T/F?

Back 8

T

Front 9

Word-finding and naming difficulties occur early in the disease.

Back 9

F - These signs occur later. Impoverished vocabulary, simplified phrases and ability to understand and use methaphors/analogy are diminished

Front 10

What happens to language in advanced dementia?

Back 10

Communication may be lost
Meaningless echos
Mutism

Front 11

Define apraxia

Back 11

The inability to perform an intentional act though the motor and sensory systems and are intact

Front 12

How is constructional apraxia tested?

Back 12

Ask patient to draw a house or clock-face

Front 13

Define agnosia

Back 13

The inability to understand the significance of sensory stimuli, even though the sensory pathways are intact

Front 14

How is astereognosia tested for?

Back 14

patients are asked to identify keys, coins or other everyday objects placed in their hands while keeping their eyes closed (failure to identify three-dimensional form)

Front 15

Agraphagnosia is the misidentification of faces

Back 15

F - inability to identify numbers traced on the palms of their hands.
Prosopagnosia is the misidentification of faces

Front 16

Symptoms of depression tend to be a feature of late rather than early cases of dementia.
T/F?

Back 16

F - early; patients as less cognitively impaired

Front 17

It is possible to treat patients with dementia with antidepressents, especially after a trial period of 6-8 weeks

Back 17

T

Front 18

Capgras syndrome is the presence of infestation.
T/F

Back 18

F - Delusion that people known by the patient have been replaced by imposters

Front 19

Most common type of delusion in dementia?

Back 19

Persecutory (fear of personal harm/theft of property)

Front 20

Hallucinations are experienced as originating in the mind
T/F

Back 20

F - They have the same quality as a true percept

Front 21

What % of dementia patients experience hallucinations during the course of their illness?

Back 21

50%

Front 22

Name 4 types of misidentification syndrome.

Back 22

1. Intruders in the patient's home
2. Mirror reflection
3. TV images
4. Individual people

Front 23

Behavioral disturbances are associated with later stages of dementia.
T/F?

Back 23

T

Front 24

Name the behavioural disturbances seen in dementia. (WASHES)

Back 24

Wandering
Agression
Sexual disinhibition
Hyperorality (inapropriate objects put in mouth)
Eating increased
Sleep disturbance

Front 25

Alzheimers and LBD account for 85-90% of dementia cases.
T/F?

Back 25

F - Alzheimer's and Vascular

Front 26

Alzheimer's or vascular dementia?
Focal disease

Back 26

Vascular

Front 27

Alzheimer's or vascular dementia?
Fits and HT rare

Back 27

Alzheimer's

Front 28

Alzheimer's or vascular dementia?
Personality preservation

Back 28

Vascular

Front 29

Alzheimer's or vascular dementia?
Catstrophic reaction

Back 29

Vascular (insight remains)

Front 30

Alzheimer's or vascular dementia?
Affective Sx uncommon

Back 30

Alzheimer's (blunted affect)

Front 31

Alzheimer's or vascular dementia?
60% of dementia

Back 31

Alzheimer's (Vascuar is 30%)

Front 32

Alzheimer's or vascular dementia?
Females > Males

Back 32

Alzheimer's
(Vascular males>females)

Front 33

Alzheimer's or vascular dementia?
Sudden onset

Back 33

Vascular
(Alzheimers has insideous onset)

Front 34

Course of Vascular dementia?

Back 34

Stepwise deterioration (strokes)

Front 35

Alzheimer's or vascular dementia?
Somatic complains are rare

Back 35

Alzheimers (more common in vascular)

Front 36

What is the single most important determinant of an accurate diagnosis when considering dementia?

Back 36

Detailed hx from an informative carer

Front 37

Fundamental aspects of hx for possible dementia? (2)

Back 37

Mode of onset and duration

Front 38

How many items in the MMSE?

Back 38

30

Front 39

What is the suggested cut-off for cognitive decline and normal on the MMSE?

Back 39

23-24

Front 40

What is an important consideration in the decision to admit someone for Ix?

Back 40

Support at home

Front 41

Which member of the MDT is important from an early stage?

Back 41

Social worker-finances, work, housing, living condition
OT and physio also important

Front 42

Which blood tests are carried out to exclude other pathology?

Back 42

FBC
ESR (infection, encephalitis)
Glucose (hypoglycaemia)
U&Es
LFTs
TFTs (hypothyroidism)
Vit B12 and folate
Syphilus (neurosyphilis)

Front 43

Important imaging test when condidering dementia?

Back 43

Brain CT

Front 44

When most-likely diagnosis is vascular, what is prescribed?

Back 44

Asprin

Front 45

Minimum requirement for prescribing Aricept/Exelon/Galantamine is:

Back 45

a. diagnosis of probable Alzheimer's disease
b. MMSE > 10
c. Available carer to administer medication
d. No complicated PMH

Front 46

Dementia is only diagnosed for sx present over 1 year.
T/F?

Back 46

F - 6 months

Front 47

Dementia is a syndrome.
T/F?

Back 47

T

Front 48

Early onset dementia is diagnosed when the patient is <55 years old.
T/F?

Back 48

F - <65 years

Front 49

What proportion of dementia patients are in care?

Back 49

20% (80% at home)

Front 50

Proportion of people aged 65+ with dementia?

Back 50

5%

Front 51

Proportion of people aged 80+ with dementia?

Back 51

20%

Front 52

Proportion of people aged 85+ with dementia?

Back 52

25%

Front 53

Proportion of people aged 90+ with dementia?

Back 53

30%

Front 54

Fronto-temporal dementia is the commonest type of dementia in <65s.
T/F?

Back 54

F - It is the 2nd commonest; Alzheimer's is still the commonest (obviously)

Front 55

Name the three common sx of LBD.

Back 55

1. Fluctuating cognition
2. Hallucinations (commonly visual)
3. Parkinsonian features
(also associated with increased risk of falls, disturbed consciousness and autonomic dysfunction)

Front 56

Fluctuation, challenging behaviours and neurological signs are common in which type of dementia?

Back 56

Vascular dementia

Front 57

Motor neurone disease may cause which type of dementia?

Back 57

Fronto-temporal (as can Pick's)

Front 58

Name 5 differentials that may present like dementia

Back 58

Space occupying lesion
Vit B12/thiamine deficiency
Normal pressure hydrocephalus
Neurosyphilus
Severe hypothyroidism

Front 59

Think of 6 possible approaches to treating AD (not including anti-AD) that may be increasingly used

Back 59

Neuroprotective drugs
Antioxidants and Vit E
HRT
NSAIDS
Gene therapy
Stem cells