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

Outline

Background

• Dementia is sadly the leading cause of death in the developed world. 

• Dementia is a chronic global brain failure state characterised by reduction in cognition in at least two domains

Assessment

Presentation

• Poor memory, poor cognition

• Not coping at home, falls, 

• Concerns from family, isolation

Examination

• MOCA < 26/30

• Frailty

• Poor at following instructions

Investigations

• Reversible Dementia Screen

  • CT-H

  • Baseline: FBC, U&Es, CRP, LFTs

  • B12, Folate, Ca/Mg/PO4, glucose, TFT

Diagnosis

Classification (Dementia Subtypes)

• Alzheimer's Disease, 

• Vascular Dementia, 

• Lewy Body Dementia, 

• Frontal Temporal Dementia, 

• Korsakoff's Dementia

• Reversible Causes of Dementia (see below)

Management

MDT

• • Psychiatry consultant- memory clinic referral, Geriatrics- admissions

  • Physio- mobility aids

  • OT- home adjustments, falls alarms

  • 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- home carers/ nursing home

Lifestyle

• Nutrition, mood, relationships, exercise, fall

Medication

• Symptomatic: agitation- antipsychotics + BDZ

• Disease modifying medication as per subtype

Disease Cycle

New Diagnosis of Dementia

Referral to Memory Clinic

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 Encephalitis, CJD

  • Urine Drug screen

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

Aetiology

Dementia Subtypes

Alzheimer's Disease

• Cholinesterase inhibitors & memantine

• Memantine causes bradycardia so ECG required

• Insidious onset

Vascular Dementia (VD)

• Vasculopathy risk factors- Hypertension, arterial clots- Stroke, Coronary Artery Disease, smoker

• MCQ- stepwise factor

• Hypertensive encephalopathy likely under recognised and treated

Lewy Body Dementia (LBD)

• Links with Parkinson's Disease 

• Dementia with hallucinations

Frontal Temporal Dementia (FTD)

• Dementia with behavarioural change

Reversible Causes of Dementia

CNS

• • Normal pressure hydrocephalus, 

  • Space occupying lesion- e.g. CNS malignancy

  • Subdural Haematoma

  • CNS infection, AI Encephalitis, CJD

Systemic

• • Vitamin & Electrolytes: 

    • B12, Folate, B3 (Niacin)

    • Hypercalcaemia, Hyponatraemia, Hypomagnesaemia,

  • Endocrine: Hypothyroidism, Diabetes

  • Infection screen: Sepsis

    • HIV & Syphilis

  • Malignancy

  • Medication & illicit drug- Korsakoff's Dementia

Prognosis

In the UK, patients live on average for 5 years after a diagnosis and they have usually had the condition for many years prior to this. 

Complications

• Death and Dying

• Infections: Pneumonia, UTIs, 

• Falls: Hip Fractures

• Malnutrition

• Anxiety, agitation, depression

Resources & References

Links

• Body System: Nervous System 

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

Written in 2025.