Skip to content
GERICLINICS

GeriQBank · Paper III · Q2

Dementia

High YieldAsked ×220-mark essay + 6-mark note
Topic
Dementia & Cognition
Chapter
Dementia & Cognitive Disorders
Years asked
Not recorded in the source
Frequency
Set 2× in Paper III (2009–2025)

As set in the university paper

  • Discuss dementia in the elderly and its management.

    Paper III · Cognition, Dementia & Delirium · asked ×2 · 20-mark essay + 6-mark note · see in paper list

Answer framework

  1. Definition — acquired, progressive decline with functional loss in clear consciousness
  2. Three-question triage — delirium, reversible physical factors, pseudodementia
  3. Causes with numbers — AD, vascular, DLB, FTLD, reversible
  4. Cortical versus subcortical dementia
  5. Investigation panel — blood tests, imaging, selected tests
  6. Management in four lines
  7. Indian context and what changed after the textbook

An exam answer plan drawn from the detailed answer below. Use it to attempt the question first.

Detailed answer

Pro · free in beta
Attempt it firstOutline your answer as a 20-mark essay + 6-mark note before revealing it — definition, causes, evaluation, management and the geriatric angle.Reveal answer

Short revision answer

  • Dementia is an acquired, progressive, sustained decline in memory and other cognitive domains with loss of daily function, in clear consciousness (DSM-5: major neurocognitive disorder).
  • Before diagnosing it, ask three questions: Was the onset acute? (delirium) Are there physical factors — illness, sensory loss, drugs? (a reversible contribution) Are there psychological factors — depression, psychosis? (pseudodementia)
  • Causes: AD 50–60%, vascular 15–25%, DLB 15–25% (autopsy series), FTLD 3–20% (second commonest under 65); truly reversible <4%.
  • Cortical dementia (AD, large-vessel VaD): prominent memory loss with aphasia, apraxia and agnosia. Subcortical dementia (small-vessel VaD, PDD, PSP): executive dysfunction, depression and apathy, gait disturbance and extrapyramidal signs.
  • Investigations: CBC, glucose, urea, electrolytes, calcium and phosphorus, LFTs, TSH, B12, and VDRL and HIV if suspected; CT or MRI head; in selected cases neuropsychological testing, CSF Aβ42 and p-tau, PET, or plasma p-tau217.
  • Management: treat reversible causes and vascular risk; stop anticholinergics; a cholinesterase inhibitor for mild–moderate AD and memantine for moderate–severe AD (combine for added effect); non-drug approaches first for behaviour (DICE, caregiver training, exercise, routine, a safe environment).
  • India: LASI-DAD found 7.4% of those aged 60+ affected — 8.8 million people, projected 16.9 million by 2036. Supports include NPHCE, Elder Line 14567, the Ayushman Vay Vandana Card (70+), the Senior Citizens Act 2007 and ARDSI.
  • Since the textbook: lecanemab (2023), donanemab (2024), plasma p-tau217 (2025), biological criteria (2024), the Lancet Commission's 14 risk factors with 45% preventable, and brexpiprazole (2023) and dextromethorphan–bupropion (2026) for agitation.

Condensed by GeriClinics from the detailed answer below, with no new facts added.

Dementia.

Note: This question repeats Question 1 in condensed form. A rapid-recall sheet is given below rather than a repeated full answer — use it for final-night revision and refer to Question 1 for the expanded treatment.

Rapid-Recall Sheet — Dementia

1.

DEFINITION IN ONE LINE Acquired, progressive, sustained decline in memory and other cognitive domains causing loss of function in daily living, in clear consciousness (DSM-5: major neurocognitive disorder).

2.

THE THREE-QUESTION TRIAGE BEFORE DIAGNOSING DEMENTIA

1.

Was the onset acute (hours to days)? → think delirium

2.

Are there physical factors (illness, sensory deprivation, drugs)? → think reversible contribution 3. Are there psychological factors (depression, psychosis)? → think pseudodementia 3. CAUSES — THE NUMERICAL ANCHORS Type Share Alzheimer’s disease 50–60% Vascular / vascular cognitive impairment 15–25% Dementia with Lewy bodies 15–25% (autopsy series) Frontotemporal lobar degeneration 3–20%; 2nd commonest under 65 Truly reversible <4%

4.

CORTICAL VS SUBCORTICAL — THE DISCRIMINATOR TABLE Feature Cortical Subcortical Memory Prominent impairment Milder deficit Executive function Usually present Prominent Cortical signs Aphasia, apraxia, agnosia Absent Mood Less prominent Depression, lability, apathy Motor Field cut, UMN signs Gait disturbance, extrapyramidal signs, dysphagia Example AD, large-vessel VaD Small-vessel VaD, PDD, PSP

5.

INVESTIGATION PANEL (MEMORISE AS A BLOCK) Blood: CBC · glucose · blood urea · electrolytes · calcium and phosphorus (mg/dL) · LFT · TSH (µIU/mL) · vitamin B12 (pg/mL) · VDRL and HIV if suspected Imaging: CT or MRI head — mandatory in recent-onset dementia, unexplained picture, or focal signs Selected: neuropsychological testing · CSF Aβ42 and p-tau · amyloid/FDG-PET · plasma p-tau217

6.

MANAGEMENT IN FOUR LINES

1.

Treat reversible causes and comorbidity; control vascular risk factors

2.

Stop anticholinergics and other cognition-worsening drugs

3.

ChEI for mild–moderate AD; memantine for moderate–severe; combine for added symptomatic effect 4. Non-pharmacological first for behaviour — DICE approach, caregiver training, exercise, structured routine, safe environment

7.

INDIAN CONTEXT IN ONE PARAGRAPH LASI-DAD: 7.4% prevalence in 60+, 8.8 million cases, projected 16.9 million by 2036, higher in women and rural residents. Care is delivered through NPHCE (district geriatric units, regional geriatric centres), Elder Line 14567, AB-PMJAY and the Ayushman Vay Vandana Card for those 70+, the Maintenance and Welfare of Parents and Senior Citizens Act, 2007 for neglect and abandonment, Rashtriya Vayoshri Yojana for assistive devices and ARDSI for caregiver support and the Dementia India reports.

8.

WHAT CHANGED AFTER THE TEXTBOOK Anti-amyloid antibodies (lecanemab 2023, donanemab 2024) · plasma p-tau217 FDA-cleared 2025 · 2024 Alzheimer’s Association biological criteria · Lancet Commission 2024: 14 risk factors, 45% preventable · brexpiprazole 2023 and dextromethorphan–bupropion 2026 for agitation.

How was your recall?

Rating marks the question complete. “Need another pass” also adds it to your bookmarks.

References

Spotted an error or something out of date?Report a problem with this page