Correct answer: The statement is false. It is important to
recognise that not all types of dementia are progressive and incurable.
For example, although dementia that results from conditions such as
Alzheimer's disease and Lewy Body disease is progressive and incurable—certain
medical conditions which may manifest in dementia-like symptoms, such as Vitamin B12
deficiency and hypothyroidism, are amenable to treatment.
Correct answer: No. Use of these imaging tests may identify causative
factors for dementia. However, they are not able to identify the specific
neurological characteristics of some forms of dementia such as: (a) Lewy Bodies
(found in Lewy Body dementia): and (b) neurofibrillary tangles (found in
fronto-temporal dementia and Alzheimer's disease). These signs can only be
definitively determined after death when an autopsy is performed.
Please note: In Question 4 (below), the term
"multi-infarct dementia" is used. The term "vascular dementia" is now the more commonly
used term.
Question 4: A 75 year old man presents with the gradual onset of cognitive
impairment, which is fluctuating, together with falls, visual hallucinations, and
Parkinsonism. What is the most likely diagnosis? (Clue: This is one of the rarer
types of dementia).
Multi-infarct dementia
Alzheimer's disease
Lewy Body dementia
Correct answer: Lewy Body dementia involves insidious impairment of
executive function with Parkinsonism, visual hallucinations, fluctuating
cognitive abilities, and increased risk of falls or autonomic failure.
Multi-infarct dementia involves a stepwise deterioration in executive
function with or without language and motor dysfunction. Patients usually
have risk factors for atherosclerosis (such as diabetes, hypertension, and
smoking). It tends to have a more sudden onset and stepwise progression than
Alzheimer's disease.
Alzheimer's disease is characterised by an insidious onset and slow
deterioration.
References:
McKeith, I.; Galasko, D.; Kosaka, K.; Perry, E.; Dickson, D.; et al.
(1996) Consensus guidelines for the clinical and pathological diagnosis
of dementia with Lewy bodies (DLB): Report of the consortium on DLB
International Workshop Neurology 47:1113-1124 (abstract only) [Available at
http://www.neurology.org/cgi/content/abstract/47/5/1113
Accessed Jan 2008]
Cumulative Reflection Exercise:
Now that you have an introductory understanding of screening and assessment for
dementia, consider your specific health professional focus and reflect on:
How you have contributed or could contribute to the recognition of dementia
in people for whom you provide care.
Do you now see your role differently? If so, in what way(s) do you see your
role differently? If not, why not?
Module 2: Recognising Dementia