Psych Vivas · Old age psychiatry — neurocognitive disorders
Young-onset dementia — structured clinical viva
Fellowship viva covering YOD definition, epidemiology anchors, EOAD gene triad, work-up, donepezil dosing principles, Schneider mortality signal, and Appelbaum capacity.
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Target exams
Interpretation
Reveal interpretation
Define YOD as dementia with onset before 65 years; cite global prevalence context (~119/100,000 aged 30–64) and that differentials reweight toward EOAD, FTD, vascular, alcohol-related, and treatable/genetic rarities.[1][2]
This pedigree-rich amnestic-executive presentation favours familial EOAD; name APP, PSEN1, PSEN2 and insist on genetic counselling before testing.[3][4][8] Still exclude FTD and other mimics with phenotype, MRI, and selective biomarkers.[9][10]
If AD is confirmed, offer donepezil 5 mg oral daily → 10 mg after 4 weeks if tolerated with cholinergic monitoring.[5] Antipsychotics only for severe risk BPSD; cite mortality increase from meta-analysis.[6] Capacity is decision-specific (Appelbaum); address driving and employment as core medical issues.[7]
Key points
[1] [3] [4] [7]References
- [1]Rossor MN, Fox NC, Mummery CJ, Schott JM, Warren JD The diagnosis of young-onset dementia Lancet Neurol, 2010.PMID 20650401
- [2]Hendriks S, Peetoom K, Bakker C, et al. Global Prevalence of Young-Onset Dementia: A Systematic Review and Meta-analysis JAMA Neurol, 2021.PMID 34279544
- [3]Sherrington R, Rogaev EI, Liang Y, et al. Cloning of a gene bearing missense mutations in early-onset familial Alzheimer's disease Nature, 1995.PMID 7596406
- [4]Goate A, Chartier-Harlin MC, Mullan M, et al. Segregation of a missense mutation in the amyloid precursor protein gene with familial Alzheimer's disease Nature, 1991.PMID 1671712
- [5]Birks JS, Harvey RJ Donepezil for dementia due to Alzheimer's disease Cochrane Database Syst Rev, 2018.PMID 29923184
- [6]Schneider LS, Dagerman KS, Insel P Risk of death with atypical antipsychotic drug treatment for dementia JAMA, 2005.PMID 16234500
- [7]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [8]McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease Alzheimers Dement, 2011.PMID 21514250
- [9]Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia Brain, 2011.PMID 21810890
- [10]Arvanitakis Z, Shah RC, Bennett DA Diagnosis and Management of Dementia: Review JAMA, 2019.PMID 31638686