Dementia

Exam Cram

• Dementia is the medical term for chronic brain failure and one of the leading causes of morbidity and mortality in the developed world

• Presentation: insidious onset- forgetfulness, emotional irritability, not following conversations or making mistakes, weight loss, low mood

• Diagnosis: clinical- after ruling out reversible causes

• Management: MDT & lifestyle, medical mangement as per underlying cause

Disease Cycle

New Diagnosis of Dementia

History & Examination

• Collateral history from family

Investigations

• Rule out reversible causes of dementia

  • CT-H: normal pressure hydrocephalus, Space occupying lesion- e.g. CNS malignancy

  • Vitamin & electrolytes: B12, folate, hypercalcaemia, hyponatraemia, hypomagnesaemia

  • Endocrine: TFTs for hypothyroidism, blood sugar- diabetes

  • Infection screen

• If young & acute behavioral change, consider

  • Infections: HIV & Syphilis 

  • Lumbar puncture: ?CNS infection, ?AI (Autoimmune) Encephalitis, CJD

  • Urine Drug screen

  • Septic screen: CXR, urine dip/ culture, blood cultures, viral PCR, baseline bloods

Management

• Discussion with psychiatry & referral to memory clinic for diagnosis of subtype

• Antipsychotics- e.g. risperidone for agitation

• MDT

  • Pyschiatry consultant

  • Physio- ensure mobility safe

  • OT- home adjustments

  • Dietician- ensure weight stable

  • Psychology if mood low

  • Family discussions

  • Advanced planning for DNR, ward level, advance directive, wishes in End of Life Care 

  • Social work- plan for package of care, nursing home placement

Classification

Alzheimer's Disease

• cholinesterase inhibitors & memantine

Lewy Body Dementia (LBD)

• inks with Parkinson's Disease 

Frontal Temporal Dementia (FTD)

Resources & References

Links

• Body System: Nervous System 

• Specialty: Psychiatry (due to experience with psychotropics), Geriatrics and rarely Neurology 

Written in 2025.