1. Alzheimer’s Disease

Features: Gradual onset, memory loss (especially recent), disorientation, language difficulties.

Assessment:

Mini-Mental State Exam (MMSE)

Montreal Cognitive Assessment (MoCA)

Brain MRI: hippocampal atrophy

Treatment:

Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine)

NMDA antagonist (memantine in moderate-severe cases)

Cognitive stimulation therapy

2. Vascular Dementia

Features: Stepwise decline, focal neurological signs, history of stroke or TIA, gait disturbance.

Assessment:

CT/MRI: infarcts, white matter changes

Vascular risk profile: BP, cholesterol, glucose

Treatment:

Control of risk factors (hypertension, diabetes, smoking)

Antiplatelets/statins if indicated

Supportive care, no specific drug approved

3. Lewy Body Dementia

Features: Fluctuating cognition, visual hallucinations, Parkinsonism, REM sleep disorder.

Assessment:

MoCA or MMSE

DaTscan (dopaminergic imaging may help)

Neuropsychiatric assessment

Treatment:

Rivastigmine is preferred

Avoid antipsychotics (may worsen symptoms)

Parkinson’s meds cautiously if needed

4. Frontotemporal Dementia (FTD)

Features: Early personality changes, social disinhibition, language issues, younger onset (40–65).

Assessment:

Cognitive testing (especially executive function)

MRI: frontal and/or temporal lobe atrophy

Neuropsychological testing

Treatment:

No licensed drug

SSRIs may help with behaviour

Supportive and behavioural therapy

5. Mixed Dementia

Features: Combination of Alzheimer’s and vascular features.

Assessment: Mixed imaging and clinical signs

Treatment: Target both vascular risk factors and consider Alzheimer’s treatments

General Dementia Management:

Non-Pharmacological: Cognitive stimulation therapy, physical activity, social engagement

Advanced Care Planning: Power of attorney, future preferences

Carer Support: Education, respite services

Regular Review: Safety, nutrition, mental health

Dr Geranmayeh