27-10-23 - Introduction to neuropsychiatry Flashcards
Learning outcomes
- Learn the localisation of cerebral functions
- Learn the brain regions affected by common neurological conditions
- Understand why these neurological conditions produce particular patterns of symptoms and signs
- Understand the concept of functional neurological disorder
Describe the The Spectrum of Behavioural and Psychological Symptoms of Dementia (BPSD) (in picture)
How common are BPSD, or neuropsychiatric symptoms?
When do they present?
When are they more common?
Who can these symptoms be problematic to?
What is this associated with?
- Most (90%) patients have BPSD or neuropsychiatric symptoms, often multiple
- Present throughout the course of the disease, and may remit, but they are highly recurrent
- They are likely to be the most problematic aspect for carers and a major source of caregiver distress
- BPSD and neuropsychiatric symptoms are strongly associated with nursing home placement
What are BPSD or neuropsychiatric symptoms caused by?
What do features vary according to?
What are pre-disposing factors?
- BPSD or neuropsychiatric symptoms are caused by complex interaction between anatomical, biochemical and functional changes
- Features vary according to severity and type of dementia as different brain regions affected
- Predisposing factors are genes and premorbid personality
Describe the function of each lobe of the brain (in picture)
Where in the brain is affected by Alzheimer’s initially? (in picture).
Describe what the diagnosis of probable Alzheimer’s disease is supported by.
Describe other clinical features consistent with the diagnosis of probably AD after exclusion of causes of dementia other than AD.
Where in the brain is affected by dementia with Lewy bodies.
What is Lewy body dementia (LBD aka DLB).
Describe 2 core features essential for a diagnosis of probable, with one being essential for possible LBD (in picture).
Describe features that are supportive of the diagnosis of LBD
- Dementia with Lewy bodies affects the occipital lobe (DLB aka LBD)
- Lewy body dementia (LBD) is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain.
DLB
How is DLB and PD dementia similar?
How are they distinguished?
What are 4 More pronounced features in DLB compared to PDD?
What deficits are the same in DLB and PDD?
How can we find out all of this information?
- Dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) are separate entities which share many clinical, neurochemical and morphological features
- Distinction based on time of onset of motor and cognitive symptoms
- Motor symptoms first, then dementia a few years later – will often be given the diagnosis of Parkinson’s dementia
- If there are cognitive symptoms first, then motor symptoms – often the diagnosis of DLB is given
- 4 More pronounced features in DLB compared to PDD:
1) More pronounced cortical atrophy
2) Elevated cortical and limbic Lewy body pathologies
3) Higher Aβ and tau loads in cortex and striatum in DLB compared to PDD
4) Earlier cognitive defects in DLB.
- No differences in cortical and striatal cholinergic and dopaminergic deficits in DLB and PDD
- We won’t know any of this information until we put the patient in a PET scanner
Describe the behavioural disorder and affective symptoms associated with fronto-temporal dementia (in picture)
Why is there a wide range of symptoms in vascular dementia?
Why is there a stepwise progression is vascular dementia?
How dies this compare to AD?
How common is vascular dementia?
What can it co-exist with?
Describe clinical features consistent with the diagnosis of probably vascular dementia (in picture)
- There is a wide range of symptoms in vascular dementia as it can affect all areas of the brain
- There is a stepwise progression in vascular dementia due to infarcts
- AD is a lot more gradual
- Vascular dementia is the 2nd commonest dementia, and can co-exist with other dementias e.g Alzheimer’s dementia
What can be the first presentation of Multiple sclerosis (MS)?
What are 9 NS symptoms associated with MS?
- Neuropsychiatric symptoms (NS) are common and can be first presentation of MS
- 9 NS symptoms associated with MS:
1) Dysphoria (a mental state in which a person has a profound sense of unease or dissatisfaction.)
2) Agitation
3) Anxiety
4) Irritability
5) MDD (major depressive disorder)
* ~50%- very high rates, likely to reflect cortical damage, not just reaction to disability
6) Suicide
7) Mania
* e.g oribitofrontal prefrontal cortex-impulsivity, mood lability, personality changes seen in mania
8) Pseudobulbar affect (PBA)
* a neurological condition that causes outbursts of uncontrolled or inappropriate laughing or crying. These episodes don’t match your internal emotional state
* 10% MS patients-disconnect between mood and affect- ‘tears without sadness’
9) Psychosis
* 2-3 x more common in MS patients compared to general population e.g medial temporal damage
How is the brain affected in Huntington’s disease (HD).
What type of disorder is HD?
What symptoms and signs are common?
Which symptoms are rare?
What is maintained until late stages of HD?
How high are suicide rates in HD?
- In Huntington’s disease (HD) Abnormal huntingtin protein leads to degeneration of neurons particularly caudate, putamen and cerebral cortex
- HD is a progressive dementia and movement disorder
- Early depression and behavioural disturbances common - especially irritability, apathy, anxiety, dysphoria and agitation- independent of cognitive and motor aspects
- Psychotic symptoms rare
- Insight retained until late stages (the capacity to gain an accurate and deep understanding of someone or something.)
- High suicide rate associated with HD - ~ 10%
What is another name for Motor neuron disease?
Do motor or neuropsych symptoms come first in Motor Neurone Disease (ALS)?
How common are cognitive and behavioural deficits in ALS?
How are Familial MND and FTD linked?
- Amyotrophic lateral sclerosis (ALS), also known as classical motor neuron disease (MND)
- In Motor Neurone Disease (ALS) neuropsych symptoms may precede motor symptoms
- Cognitive and behavioural deficits in up to 50% - executive function, social and language deficits, dementia (35% mild problems, 15% full blown frontotemporal dementia – FTD)
- Familial MND and FTD have genetic overlap - trinucleotide expansion in C9orf72
What are 5 Synonyms of Functional Neurological Disorder (FND)?
How common are they in neurology clinic patients?
- 5 Synonyms of Functional Neurological Disorder (FND):
1) Functional movement disorder
2) Conversion disorder
3) Psychogenic seizures / movement disorder
4) Dissociative seizures / motor disorder
5) Non-epileptic seizures - Functional neurological disorders occur in about one quarter of neurology clinic patients
