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Neurology Week 5 2018/19 > 1: Cognitive neurology > Flashcards

1: Cognitive neurology Flashcards

1
Q

What is cognition?

A

Mental action of acquiring and understanding knowledge

Using thought, experience and senses

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2
Q

What is the general definition of dementia?

A

Significant cognitive decline

interfering with daily activities

not explained by other processes

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3
Q

Dementia tends to be a (sudden / progressive) disease.

A

progressive decline in cognition

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4
Q

Which percentage of over 65s have been diagnosed with dementia?

A

Around 7%

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5
Q

What is one of the biggest risk factors for developing dementia?

A

Increasing age

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6
Q

Which infections can cause dementia?

A

HIV

Syphilis

Prion disease (i.e contact with the misfolded protein)

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7
Q

What acute neurological diseases cause a decline in cognition?

A

Viral encephalitis

Head injury

Stroke

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8
Q

What are the symptoms of transient global amnesia?

A

Amtegrade amnesia (difficulty laying down new memories)

Retrograde amnesia (loss of short term memories)

but preserved knowledge of self

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9
Q

Transient global amnesia typically lasts how long?

A

4 - 6 hours

Never more than 24 hours

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10
Q

What can trigger transient global amnesia?

A

Emotions

Changes in temperature

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11
Q

Which type of amnesia is short-lived compared to transient global amnesia but tends to be a recurrent problem?

A

Transient epileptic amnesia

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12
Q

Which brain structure is found in the temporal lobe and has a role in learning and memory?

A

Hippocampus

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13
Q

What is the clinical name for ‘everyday forgetfulness’ which impacts daily living?

A

Functional cognitive impairment

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14
Q

What is the course of functional cognitive impairment (‘everyday forgetfulness’)?

A

Fluctuating

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15
Q

What are the courses of

a) functional cognitive deficit
b) dementia?

A

a) Fluctuating

b) Progressive decline

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16
Q

What disorders need to be excluded in forgetful patients?

A

Dementia

Mood disorders

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17
Q

What is a prion disease?

A

Disease caused by misfolded proteins

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18
Q

What is a well-known prion disease causing rapid brain degeneration?

A

Creutzfeldt-Jakob disease (CJD)

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19
Q

In which age of patient does CJD tend to present?

A

60s

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20
Q

What are the clinical features of sporadic CJD?

A

Rapid onset dementia

Myoclonus

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21
Q

What is the average life expectancy of a patient diagnosed with CJD?

A

4 months

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22
Q

What is the cause of CJD?

A

Misfolded protein

23
Q

What investigations are used to diagnose CJD?

A

EEG

MRI brain

Lumbar puncture (CSF markers)

24
Q

What is a common disease causing gradual-onset dementia?

A

Alzheimer’s disease

25
Q

Alzheimer’s disease is a ____ condition causing dementia.

A

neurodegenerative

26
Q

What are the clinical features of Alzheimer’s disease?

A

Forgetfulness

Apraxia

Visual problems

27
Q

At what age do patients tend to develop Alzheimer’s disease?

A

> 65

28
Q

Younger patients who are diagnosed with Alzheimer’s disease tend to have ___ symptoms.

A

atypical

visual disturbances. aphasia

29
Q

What are the atypical symptoms of Alzheimer’s disease?

A

Visual disturbances (feeling like you’re going to step into a pit)

Aphasia (difficulty communicating, naming things)

30
Q

How is Alzheimer’s disease investigated?

A

MRI brain - atrophy of temporal lobes

Lumbar puncture - amyloid in CSF sample (not specific)

31
Q

What neurotransmitter is inhibited in Alzheimer’s disease?

A

ACh

32
Q

Which two classes of drugs can give symptomatic relief in Alzheimer’s disease?

A

Anticholinesterase inhibitors (e.g donepezil, rivastigmine) - ACh thought to be involved

NMDA antagonists - remember that NMDA is involved in excitatory neurotransmission

33
Q

What is a disease causing early-onset (i.e < 65) dementia with behavioural symptoms?

A

Frontotemporal dementia

34
Q

What is another name for frontotemporal dementia?

A

Pick’s disease

35
Q

What are clinical features of frontotemporal dementia?

A

Loss of inhibition

Apathy

Lack of empathy

Obsessive, compulsive behaviour

36
Q

Which type of history can be crucial in diagnosing patients with dementia?

A

Collateral history

37
Q

Which lobes are atrophied on the MRI of someone with frontotemporal dementia?

A

Frontal / temporal lobes

38
Q

Patients with frontotemporal dementia should have their access to food, money and the internet closely monitored - why?

A

Loss of inhibitions

39
Q

Which type of dementia is linked to the same processes as stroke?

A

Vascular dementia

40
Q

What causes vascular dementia?

A

Atherosclerosis > Infarct of areas responsible for memory, processing etc.

Haemorrhage > Infarct “” “” “”

41
Q

Which bodies, seen in Parkinson’s disease, can also cause a late-onset dementia?

A

Lewy bodies

42
Q

Which protein is implicated to cause Lewy body dementia?

A

Alpha synuclein

43
Q

What are the clinical features of Lewy body dementia?

A

Declining cognition

Visual hallucination

Extra-pyramidal ‘Parkinsonian’ symptoms - tremor, hypokinesia, rigidity

44
Q

Which scan is used to measure dopamine uptake from the basal ganglia and can support a diagnosis of Parkinson’s disease or Lewy body dementia?

A

DaT scan

45
Q

What is the name for a dopamine precursor which can be given to reduce symptoms in PD and Lewy body dementia?

A

Levodopa

46
Q

Which two diseases, involving Lewy bodies and alpha synuclein, can occur together?

A

Parkinson’s disease

Lewy body dementia

47
Q

Which disease, involving CAG triplet repeats, can cause early-onset dementia in patients aged 30 - 60?

A

Huntington’s disease

48
Q

Which gene is affected in Huntington’s disease?

A

Huntingtin

49
Q

What are the symptoms of Huntington’s disease w/ dementia?

A

Chorea (rhythmic muscle contractions)

Decline in cognition

50
Q

How is Huntington’s disease treated?

A

Symptomatically

51
Q

Who tends to manage dementia in

a) under 65s
b) over 65s?

A

a) Neurology

b) Psychiatry

52
Q

Who tends to see patients with rapid-onset dementia or dementia with unusual symptoms?

A

Neurology

53
Q

How is cognition assessed?

A

ACE-III screen

54
Q

Which types of dementia are associated with

a) Lewy bodies

b) Alpha synuclein

c) CAG repeats

d) prions

e) tau proteins?

A

a) Dementia with Lewy bodies (and Parkinson’s disease)

b) “ “

c) Huntington’s disease

d) Creutzfeldt-Jacob disease

e) Alzheimer’s disease

Neurology Week 5 2018/19 (11 decks)

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