Dementias

Type of Dementia	Common Symptoms	Pathology	Risk Factors	Treatment/Management
Alzheimer’s Disease	Amnesia, aphasia, agnosia, aprexia, associated behaviours (self neglect, personality changes, disinhibitions), steady decilne	Amyloid plaques, neurofibrillary tangles in the brain	Age, family history, genetics, certain genes, head injuries, cardiovascular disease, diabetes	Medications (e.g., donepezil, rivastigmine) to slow progression, cognitive and behavioural therapies, lifestyle modifications (e.g., physical and mental activities, healthy diet, social engagement)
Vascular Dementia	Problems with reasoning, planning, memory. Step wise decline as more microclots	Reduced blood flow to the brain, often after a Stroke or other cardiovascular issues	Essential hypertension, diabetes, smoking, high cholesterol, heart disease, Stroke, transient ischemic attacks (TIAs), Atrial Fibrillation	Blood pressure management, cholesterol control, diabetes management, lifestyle changes (e.g., exercise, diet), cognitive rehabilitation
Lewy Body Dementia	Fluctuating cognition, visual hallucinations + Parkinsonism (in Parkinson’s Dementia, Parkinsonism first + primarily)	Lewy bodies (abnormal protein deposits), cognitive and motor symptoms	Age, family history, Parkinson’s disease, REM sleep behavior disorder	Medications for symptoms (e.g., cholinesterase inhibitors), physical therapy, occupational therapy, support for both the person and caregivers. No antipsychotics
Frontotemporal Dementia	Abrupt personality and behavior changes (loss of empathy, sexual disinhibition) language problems	Abnormal protein deposits in the frontal and temporal lobes	Genetic mutations (in some cases), family history	Behavioral and symptom management, speech and language therapy, cognitive rehabilitation, supportive care

Causes/Factors

1. Alzheimer’s Disease: Abnormal protein accumulation (amyloid plaques, tau tangles) - slow progression
2. Vascular Dementia: Impaired blood flow to the brain due to Stroke or other vascular issues.
3. Lewy Body Dementia: Presence of abnormal protein deposits (alpha-synuclein) in the brain.- often associated with Parkinson’s disease. No anti-psychotics
4. Frontotemporal Dementia: Degeneration of frontal and temporal lobes of the brain.

Pseudodementias

Mimic the symptoms of dementia

• Wernicke-Korsakoff syndrome
• B12/folate deficiency
• Depression
• Hypothyroid

Symptoms

1. Cognitive Decline: Memory loss, difficulty with reasoning, problem-solving, and language.
2. Behavioral Changes: Agitation, apathy, Depression, anxiety, or paranoia.
3. Motor Symptoms (in certain types): Parkinsonism, muscle rigidity, and tremors.

Signs

1. Memory Loss: Notable forgetfulness, especially recent events.
2. Impaired Judgment: Poor decision-making and inability to plan.
3. Language Problems: Difficulty finding the right words or understanding conversations.

Diagnostic Tests

1. Cognitive Assessments: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA).
2. Neuroimaging: MRI, CT scans to detect brain atrophy, structural changes, or vascular abnormalities.
3. PET Scans: Used to visualize abnormal protein deposits (e. g., amyloid, tau).
4. Blood tests: check B12
5. Urine dip/MS&C: elderly patients can become very confused and forgetful with a bad UTI

Management

1. Pharmacotherapy: Cholinesterase inhibitors (e.g., donepezil) for Alzheimer’s; memantine for moderate to severe Alzheimer’s and some other dementias. Debated efficacy
2. Symptomatic Treatment: Address behavioural and psychological symptoms using appropriate medications.
3. Non-Pharmacological Approaches: Cognitive stimulation, physical exercise, and occupational therapy.

Complications/Red Flags

1. Progressive Decline: Steady deterioration of cognitive and functional abilities.
2. Safety Concerns: Increased risk of falls, wandering, and self-neglect. Inform the DVLA if deemed unsafe to drive.
3. Caregiver Burnout: Emotional and physical exhaustion of caregivers, requiring support and respite care.

BPSD

Behavioural and psychological symptoms of dementia - can be detained under the MHA

Looks normal - physical function retained but personality changes

Behavioural

• Agitation
• Aggression
• Restlessness
• Wandering

Psychological

• Hallucinations
• Delusion
• Depression
• Anxiety