Dementia I

In this first podcast on dementia we look at the basic definitions of dementia, the causes and importance of the history in diagnosis.

 

Video Duration: 6 minutes

  • Dementia
    Created by Kate Edmonton
    General
    Epidemiology

    Acquired global impairment of higher cortical functions including memory (both short and long term). It is often progressive thought not necessarily irreversible. Thought to affect >820,000 people in the UK, and will continue to rise with our ageing population.

    Pathology
    • 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
    Top three causes
    • Alzheimers disease (65%)
    • Vascular dementia
    • Lewy Body dementia
    • Mixed vascular and AD
    Clinical Features
    Symptoms

    Reliable collateral witness is key. Memory problems: word finding difficulties, difficulty with names, geographic disorientation, disinterest in surroundings, sleep disturbance

    • Gradual memory problems - AD
    • Steep decline in memory problems and associated walking problems - Vascular dementia/ mixed VaD and AD
    • Behaviour problems (irritability and apathy) suggest frontotemporal dementia
    • Memory problems + hallucinations + symptoms of parkinson = Lewy body dementia
    Signs

    MMSE score of 24 or less suggests dementia

    Investigations
    Cultures

    MSU if delirium is a possibility

    Bloods

    FBC, U&E, LFTs, calcium, glucose, TFTs, vitamin B12 and folate levels

    Imaging

    CT/ MRI is performed to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus) and estimate prognosis.

    Scopic/Biopsy

    None

    Functional

    MMSE

    Treatment
    Conservative

    Care plan with social workers to manage tasks of daily living

    Medical
    • acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) for mild-mod AD
    • memantine (a NMDA receptor antagonist) for patients with moderate - severe Alzheimer's
    Surgical

    None