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Y3 Neurology > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

1
Q

When should you refer a dementia patient from primary care to neurology and not to psychiatry?

A

if under 65 yr or unusual feature

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2
Q

define dementia

A 
significant cognitive decline in 1+ cognitive domain 
\+ 
interferes ADL 
\+ 
no other explanation
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3
Q

imaging choice for investigating cognitive problems

A

MRI, SPECT

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4
Q

what dietary deficiencies can cause a secondary dementia

A

B1 deficiency

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5
Q

what infections can cause a secondary dementia

A

B12, syphilis, viral encephalitis

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6
Q

in transient global amnesia, is antegrade or retrograde memory more significantly effected

A

antegrade

tends to be repetitive

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7
Q

how long does transient global amnesia last?

A

always less than 24hours. generally 4-6 hours

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8
Q

which area of the brain is affected in transient global amnesia

A

hippocampus

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9
Q

what part of memory is preserved in transient global amnesia

A

knowledge of self

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10
Q

what can be the triggers for transient global amnesia

A

change in temperature or emotion

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11
Q

a patient has an acute episode where they can carry out complex activities with no recollection. what is the likely diagnosis?

A

transient epileptic amnesia

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12
Q

what is the pathology of transient epileptic amnesia

A

recurrent temporal lobe seizures

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13
Q

how long does transient epileptic amnesia last

A

20-30 minutes

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14
Q

what is the general pathology in prion diseases

A

misfolded proteins

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15
Q

what is the medical name for functional everyday forgetfulness

A

subjective cognitive impairment

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16
Q

what is a key factor in determining subjective cognitive impairment from other cognitive disorders

A

symptoms flucuate

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17
Q

investigations for prion disease

A

EEG
MRI
LP

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18
Q

what is the commonest type of prion disease?

A

sporadic prion disease

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19
Q

what is the presentation of sporadic prion disease

A

rapid dementia+ neuro signs+ myoclonus

then dead in 4 months

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20
Q

whats the other name for sporadic prion disease

A

creutzfeld jacob disease

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21
Q

what sign is seen on MRI in CJD aka sporadic prion disease

A

variant hockeystick sign

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22
Q

what CSF markers are found in CJD?

A

14-3-3

RT-QuIC

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23
Q

what type of prion disease presents with painful sensory symptoms and psychiatric problems to a PTx in their 20s? Following BSE exposure

A

variant prion disease

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24
Q

what type of prion disease has an onset in 30s with cerebellar and visual symptoms to people who were given human GH as a child?

A

iatrogenic prion disease

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25
Q

what gender is Parkinson’s more common in

A

male

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26
Q

what genotype is Parkinson’s more common in

A

HLA-DP
HLA-DQ
HLA-DR

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27
Q

what neurotransmitters are affected in PD

A

NDA
ACh
serotonin

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28
Q

area of the brain affected in PD

A

substantia nigra pars compacta

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29
Q

what component accumulates in PD

A

a-synuclein containing Lewy Bodies

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30
Q

pathology of PD

A

dopaminergic neuron dark pigment loss

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31
Q

core features of PD

A

rigidity
bradykinesia
pill-rolling resting tremor

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32
Q

is PD symmetric?

A

asymmetric

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33
Q

describe gait in PD and what word is used to describe in

A

festinating:

shuffling, small steps, turning en bloc

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34
Q

what is seen on inspection part of examination in PD

A

blank facial expression (hypomimia)

stooped posture

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35
Q

what psychiatric problems can PD present with

A

depression
later hallucinations
REM sleep

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36
Q

what is hypophonia

A

soft speech in parkinson’s disease

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37
Q

rigidity in PD is split to lead pipe and cogwheel. what is lead pipe rigidity

A

constant rigidity in passive movement

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38
Q

rigidity in PD is split to lead pipe and cogwheel. what is cogwheel rigidity

A

clicking resistance due to tremor

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39
Q

what is a glabellar tap

A

blinking in response to tapping forehead

seen in PD

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40
Q

what are some late onset features of parkinsons

A

anosmia
dementia
bladder
constipation

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41
Q

how to get a definitive diagnosis of PD

A

autopsy

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42
Q

When investigating parkinsons in a patient under 40 years, what other diseases should you exclude on investigation?

A

wilson’s

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43
Q

When investigating parkinsons in a patient aged 65, after history and examination, what investigations are required?

A

none if history and exam are in keeping with parkinson’s. trial levodopa

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44
Q

When investigating parkinson’s, if a patient presents with atypical features, such as acute onset, rapidly progressive disease, early cognitive impairment, symmetrical findings, or UMN signs, what test should you do next?

A

MRI with and without gallodium contrast

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45
Q

What is the basic of PD pharmacological management

A

Drug >dopamine conc or stimulate dopamine receptors

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46
Q

There isn’t a guideline recommended 1st line drug for PD, however what drug is most commonly used 1st

A

levodopa

47
Q

mechanism of levodopa

A

dopamine precursor that can cross the BBB, it is then converted to dopamine

48
Q

side effects of levodopa

A

daytime somnolence
nausea
long term dyskinesia

49
Q

what type of receptor to dopamine agonists act on

A

D2-type receptors

50
Q

give an example of a dopamine agonist

A

bromocriptine

51
Q

contraindications to dopamine agonists

A

OCD, addiction, elderly

52
Q

side effects of dopamine agonists

A

nausea
daytime somnolence
oedema
impulse control incl binge eating

53
Q

MAO-B inhibitors can only be used in combination with levodopa for PD Mx. T or F

A

F. can be used as monotherapy for mild disease or in combo with levodopa

54
Q

give an example of a MAO-B inhibitor

A

selegiline, rasagiline

55
Q

mechanism of a COMT inhibitor

A

prolong levodopa

56
Q

example of a COMT inhibitor

A

entacapone, -capone

57
Q

what is the use of anticholinergics in the mx of PD

A

tremor

58
Q

give examples of anticholinergics used in the mx of PD

A

trihexyphenidyl, diphenhydramine

59
Q

what is the use of amantadine in the mx of PD

A

for tremor, dystonia & levodopa induced dyskinesia

60
Q

mechanism of amantadine

A

blocks NMDA receptors

61
Q

what medications can be used for REM disorders in the mx of pd

A

clonazepam, melatonin

62
Q

what class of drug is rivastigmine

A

cholinesterase inhibitor

63
Q

what class of drug is demperidone

A

dopamine antagonist

64
Q

what is required for a dx of parkinsonism

A

bradykinesia + 1 of; rigidity, postural instability, 4-6Hz rest tremor

65
Q

what dx should you suspected when investigating parkinsons in a patient with a poor levodopa response and no resting tremor

A

vascular parkinsonism

66
Q

what drugs can cause parkinsonism

A

AEDs, metoclopramide

67
Q

is drug induced parkinsonism reversible upon stopping the drug

A

yes

68
Q

what feature on examination distinguishes drug induced parkinson’s from idiopathic parkinson’s disease

A

drug induced parkinsons is symmetrical

69
Q

what is the triad of features in multiple system atrophy

A

dysautonomia + cerebellar features + Parkinsonism

70
Q

peak age onset in multiple system atrophy

A

60-70s

71
Q

what cause of parkinsonism is a progressive condition causing symmetric axial akinetic rigidity

A

supranuclear palsy

72
Q

any genetic disorder is alzeihmer’s with

A

trisomy 21

73
Q

gender alzeihmer’s is more common in

A

female

74
Q

what gene is mutated in familial alzeihmer’s (only 1% of patients)

A

presenilin

75
Q

what age distinguishes early and late onset alzeihmer’s

A

65yr

76
Q

the ventricles dilate, gyri widen and sulci narrow in alzeihmer’s. t or f

A

f. ventricles dilate, sulci widen, gyri narrow

77
Q

what histology stain is used for alzeihmer’s

A

amyloid angiopathy congo stain

78
Q

what areas of the brain atrophy in alzeihmer’s disease

A

frontal, temporal, parietal, hippocampal

79
Q

what abnormal protein is found in alzeihmer’s disease

A

neurofibrillary tangle Tau

80
Q

initial presentation of alzeihmer’s

A

progressive mood / behaviour problem

81
Q

what is affected first in alzeihmer’s, short or long term memory?

A

short

82
Q

imaging modality of choice for alzeihmer’s

A

mri

83
Q

what is seen on SPECT scan in alzeihmer’s

A

decreased temporoparietal metabolism

84
Q

what are the csf abnormalities in alzeihmer’s

A

decreased amyloid: increased TAU

85
Q

drug management of alzeihmer’s

A

cholinesterase inhibitor or NMDA receptor blocker

86
Q

give examples of cholinesterase inhibitors

A

rivastigmine, galantamine

87
Q

give examples of NMDA receptor blockers

A

memantine

88
Q

mode of inheritance in huntingon’s

A

autosomal dominant

89
Q

what is the mutation in HD

A

CAG trinucleotide repeat mutation on the Huntington gene

90
Q

what areas of the brain are affected early on in HD

A

caudate nucleus + putamen of basal ganglia

91
Q

what areas of the brain are affected later on in HD

A

frontal / parietal lobe

92
Q

gender more commonly affected in huntigon’s

A

equal

93
Q

peak age of onset of HD

A

30-50yr

94
Q

what is seen on mri in HD

A

loss of caudate heads

95
Q

major early features of HD

A

chorea
emotional disturbance
clumsy

96
Q

later onset features of HD

A

dementia

97
Q

what protein accumulates in neurons in lewy body dementia

A

Lewy bodies a-synuclein aggregates

98
Q

peak age onset of LBD

A

over 65yr

99
Q

early signs of LBD

A

REM sleep behaviour disorder
attention
depression

100
Q

LBD effects memory later than Alzheimer’s. T or F

A

T

101
Q

later onset signs of LBD

A

visual hallucinations
parkinsonism
dementia

102
Q

is LBD fluctuating or constantly progressive?

A

fluctuating

103
Q

diagnostic criteria for LBD

A

fluctuating cognition + recurrent visual hallucinations +- extrapyramidal features

104
Q

what abormality is found in CSF in LBD

A

a-synuclein

105
Q

management options for LBD

A

small dose levodopa or rivastigmine

106
Q

having a FH of what condition is a risk factor for pick’s disease

A

MND

107
Q

what is the pathology in pick’s disease

A

extreme frontal lobe atrophy, then temporal

108
Q

peak age range for pick’s disease onset

A

50-60yr

109
Q

early signs of pick’s disease

A 
behaviour/personality.. 
disinhibition
apathy
loss of insight
lose empathy
compulsive 
hyperorality etc.
110
Q

later onset signs in pick’s disease

A

intellect
memory
language
speech

111
Q

what is seen on mri in pick’s disease

A

frontotemporal atrophy

112
Q

management of pick’s disease

A

trial trazadone or an antipsychotic

113
Q

is amyloid normal in pick’s disease

A

yes

114
Q

csf abnormality in pick’s disease

A

increase Tau protein

Y3 Neurology (23 decks)

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