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Dementia Quiz
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Which feature is required to establish a dementia syndrome after treatable causes of cognitive symptoms have been assessed?
- A Acquired cognitive decline that impairs everyday independence and is not explained solely by delirium You picked ✓
- B Acquired cognitive decline that is accompanied by stepwise deterioration after each episode of transient unilateral weakness You picked ✕
- C Acquired cognitive decline that appears during episodes of severe anxiety and improves when the anxiety is treated You picked ✕
- D Acquired cognitive decline that is restricted to episodic memory and initially spares other cognitive domains You picked ✕
- E Acquired cognitive decline that begins with visual hallucinations and parkinsonism in the absence of memory change You picked ✕
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The answer is A: Acquired cognitive decline that impairs everyday independence and is not explained solely by delirium
Explanation
Why A is correct
See Diagnosis. Option A is correct. Dementia is a clinical syndrome (a pattern of symptoms) rather than one disease. To establish it, there must be an acquired decline from the person's previous level of thinking, in areas such as memory, learning, orientation, language, judgement or planning, that is significant enough to interfere with independence in daily activities, such as managing money, medicines or cooking. The deficits must not occur only during delirium (an acute, fluctuating state of confusion, often caused by infection or another medical illness) and must not be better explained by another mental disorder, such as depression. Delirium and dementia can coexist, so an acute episode needs assessment and treatment, with the longer-term history considered separately. Before labelling someone as having dementia, treatable causes of cognitive symptoms should be checked for, such as hypothyroidism, high calcium, vitamin B12 deficiency and normal pressure hydrocephalus (a build-up of fluid in the brain's ventricles), which is why blood tests and sometimes a CT scan of the head are done. It is misleading to require that all organic causes are excluded, because dementia often has an organic cause. The functional impact is the key: memory loss alone is not dementia.
- Decline: an acquired fall from the person's previous level of thinking
- Function: severe enough to interfere with independence in daily activities
- Exclusions: not only during delirium and not better explained by another mental disorder
Why the other options are incorrect
- B. Acquired cognitive decline that is accompanied by stepwise deterioration after each episode of transient unilateral weakness: This describes a stepwise vascular dementia pattern after recurrent transient ischaemic attacks. It is an off-target clinical subtype because many people with dementia do not have cerebrovascular events or stepwise worsening. Your answer
- C. Acquired cognitive decline that appears during episodes of severe anxiety and improves when the anxiety is treated: This is a pattern of cognitive symptoms driven by anxiety, not the dementia syndrome. Symptoms that resolve when the anxiety is treated point towards another mental disorder rather than an acquired decline that is not better explained by a psychiatric cause. Your answer
- D. Acquired cognitive decline that is restricted to episodic memory and initially spares other cognitive domains: This is an amnestic pattern typical of early Alzheimer disease rather than a necessary feature of every dementia syndrome. Dementia can begin in other cognitive domains, such as language or behaviour, so this pattern is not required to establish the diagnosis. Your answer
- E. Acquired cognitive decline that begins with visual hallucinations and parkinsonism in the absence of memory change: This is the classic early pattern of dementia with Lewy bodies, not a universal requirement for every dementia syndrome. Visual hallucinations and parkinsonism are helpful clues to one subtype but are not needed to establish the syndrome generally. Your answer
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More questions from this set. Start the quiz to answer them and see each explanation.
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1
Which feature is most characteristic of frontotemporal dementia in its early stages?
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2
Which pathological change is most characteristic of Alzheimer's disease at a microscopic level?
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