Which of the following is an observational tool designed to evaluate the quality of care and well-being of people with dementia in formal care settings?
E. DCM is an observational tool designed to evaluate the quality of care and well-being of people with dementia in formal care settings. It was designed by Kitwood in 1992. DCM is based on the social–psychological theory of dementia care, which states that much of the decline in patients with dementia is a direct consequence of the social and environmental situation experienced. Better social care may result in less suffering than would otherwise be expected from their neurological state. The Washington University CDR is a global scale developed to clinically denote the presence of Alzheimer’s dementia and stage its clinical severity using semi-structured interviews with the patient and informants. The Burden Interview and Caregiver Burden Scale are used to measure the degree of caregiver strain.
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A 67-year-old retired educational psychologist presents with forgetfulness.
All of the following are features seen in mild cognitive impairment (MCI) except:
E. An array of various terms has been used to describe age-associated cognitive impairment not amounting to dementia. The most popular term is MCI, of which several types have been described of late. The amnestic MCI refers to the original description of MCI. Diagnosis of MCI requires the presence of memory complaint (preferably corroborated by an informant), objective memory impairment for age, preserved general cognitive function, normal functional activities, and no dementia. The presence or absence of family history of dementia is not a criterion used to describe MCI.
Lund–Manchester criteria are used in the diagnosis of which of the following conditions?
D. The Lund–Manchester criteria are used in the diagnosis of frontotemporal dementia. The criteria were initially developed in 1994 and were later updated in 1998. The following core components are required for a diagnosis:
Other supportive diagnostic features include:
All of the following are features of visual hallucinations reported in dementia of Lewy bodies except:
B. Visual hallucinations dominate the clinical picture of dementia with Lewy bodies (DLB) in many patients. Visual hallucinations have a tendency to persist despite treatment in many patients. In phenomenological quality, the hallucinations of DLB are similar to those reported in Parkinson’s disease dementia: they are vivid, colourful, three-dimensional, and generally mute images of animate objects. Visual hallucinations are associated with greater deficits in cortical acetylcholine and predict better response to cholinesterase inhibitors.
Two patients are admitted to an inpatient unit for elderly people with movement disturbances. Patient A has a diagnosis of Parkinson’s disease while patient B is diagnosed with dementia with Lewy bodies.
Which of the following is correct with regard to the extrapyramidal symptoms in these conditions?
C. It is reported that 25–50% of patients with DLB have extrapyramidal signs at the time of diagnosis, and another 25% develop extrapyramidal signs during the natural course of DLB. A quarter of all DLB patients have no extrapyramidal signs at all until death. So parkinsonism is not necessary for clinical diagnosis of DLB. Often a diagnosis of DLB is missed as clinicians look for extrapyramidal signs or suspect cerebrovascular disease. The pattern of extrapyramidal signs in DLB shows greater postural/gait instability and facial impassivity but less tremor. This pattern of parkinsonism is over-represented in both DLB and demented patients with Parkinson’s disease. But non-demented Parkinson’s disease patients show equal distribution of a tremor-dominant pattern and postural/gait instability pattern. It is possible that the tremor-related pattern is more dopamine-dependent dysfunction whereas postural/gait problems are more non-dopaminergic.
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