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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
what gender is Parkinson's more common in
male
26
what genotype is Parkinson's more common in
HLA-DP HLA-DQ HLA-DR
27
what neurotransmitters are affected in PD
NDA ACh serotonin
28
area of the brain affected in PD
substantia nigra pars compacta
29
what component accumulates in PD
a-synuclein containing Lewy Bodies
30
pathology of PD
dopaminergic neuron dark pigment loss
31
core features of PD
rigidity bradykinesia pill-rolling resting tremor
32
is PD symmetric?
asymmetric
33
describe gait in PD and what word is used to describe in
festinating: | shuffling, small steps, turning en bloc
34
what is seen on inspection part of examination in PD
blank facial expression (hypomimia) | stooped posture
35
what psychiatric problems can PD present with
depression later hallucinations REM sleep
36
what is hypophonia
soft speech in parkinson's disease
37
rigidity in PD is split to lead pipe and cogwheel. what is lead pipe rigidity
constant rigidity in passive movement
38
rigidity in PD is split to lead pipe and cogwheel. what is cogwheel rigidity
clicking resistance due to tremor
39
what is a glabellar tap
blinking in response to tapping forehead seen in PD
40
what are some late onset features of parkinsons
anosmia dementia bladder constipation
41
how to get a definitive diagnosis of PD
autopsy
42
When investigating parkinsons in a patient under 40 years, what other diseases should you exclude on investigation?
wilson's
43
When investigating parkinsons in a patient aged 65, after history and examination, what investigations are required?
none if history and exam are in keeping with parkinson's. trial levodopa
44
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?
MRI with and without gallodium contrast
45
What is the basic of PD pharmacological management
Drug >dopamine conc or stimulate dopamine receptors
46
There isn't a guideline recommended 1st line drug for PD, however what drug is most commonly used 1st
levodopa
47
mechanism of levodopa
dopamine precursor that can cross the BBB, it is then converted to dopamine
48
side effects of levodopa
daytime somnolence nausea long term dyskinesia
49
what type of receptor to dopamine agonists act on
D2-type receptors
50
give an example of a dopamine agonist
bromocriptine
51
contraindications to dopamine agonists
OCD, addiction, elderly
52
side effects of dopamine agonists
nausea daytime somnolence oedema impulse control incl binge eating
53
MAO-B inhibitors can only be used in combination with levodopa for PD Mx. T or F
F. can be used as monotherapy for mild disease or in combo with levodopa
54
give an example of a MAO-B inhibitor
selegiline, rasagiline
55
mechanism of a COMT inhibitor
prolong levodopa
56
example of a COMT inhibitor
entacapone, -capone
57
what is the use of anticholinergics in the mx of PD
tremor
58
give examples of anticholinergics used in the mx of PD
trihexyphenidyl, diphenhydramine
59
what is the use of amantadine in the mx of PD
for tremor, dystonia & levodopa induced dyskinesia
60
mechanism of amantadine
blocks NMDA receptors
61
what medications can be used for REM disorders in the mx of pd
clonazepam, melatonin
62
what class of drug is rivastigmine
cholinesterase inhibitor
63
what class of drug is demperidone
dopamine antagonist
64
what is required for a dx of parkinsonism
bradykinesia + 1 of; rigidity, postural instability, 4-6Hz rest tremor
65
what dx should you suspected when investigating parkinsons in a patient with a poor levodopa response and no resting tremor
vascular parkinsonism
66
what drugs can cause parkinsonism
AEDs, metoclopramide
67
is drug induced parkinsonism reversible upon stopping the drug
yes
68
what feature on examination distinguishes drug induced parkinson's from idiopathic parkinson's disease
drug induced parkinsons is symmetrical
69
what is the triad of features in multiple system atrophy
dysautonomia + cerebellar features + Parkinsonism
70
peak age onset in multiple system atrophy
60-70s
71
what cause of parkinsonism is a progressive condition causing symmetric axial akinetic rigidity
supranuclear palsy
72
any genetic disorder is alzeihmer's with
trisomy 21
73
gender alzeihmer's is more common in
female
74
what gene is mutated in familial alzeihmer's (only 1% of patients)
presenilin
75
what age distinguishes early and late onset alzeihmer's
65yr
76
the ventricles dilate, gyri widen and sulci narrow in alzeihmer's. t or f
f. ventricles dilate, sulci widen, gyri narrow
77
what histology stain is used for alzeihmer's
amyloid angiopathy congo stain
78
what areas of the brain atrophy in alzeihmer's disease
frontal, temporal, parietal, hippocampal
79
what abnormal protein is found in alzeihmer's disease
neurofibrillary tangle Tau
80
initial presentation of alzeihmer's
progressive mood / behaviour problem
81
what is affected first in alzeihmer's, short or long term memory?
short
82
imaging modality of choice for alzeihmer's
mri
83
what is seen on SPECT scan in alzeihmer's
decreased temporoparietal metabolism
84
what are the csf abnormalities in alzeihmer's
decreased amyloid: increased TAU
85
drug management of alzeihmer's
cholinesterase inhibitor or NMDA receptor blocker
86
give examples of cholinesterase inhibitors
rivastigmine, galantamine
87
give examples of NMDA receptor blockers
memantine
88
mode of inheritance in huntingon's
autosomal dominant
89
what is the mutation in HD
CAG trinucleotide repeat mutation on the Huntington gene
90
what areas of the brain are affected early on in HD
caudate nucleus + putamen of basal ganglia
91
what areas of the brain are affected later on in HD
frontal / parietal lobe
92
gender more commonly affected in huntigon's
equal
93
peak age of onset of HD
30-50yr
94
what is seen on mri in HD
loss of caudate heads
95
major early features of HD
chorea emotional disturbance clumsy
96
later onset features of HD
dementia
97
what protein accumulates in neurons in lewy body dementia
Lewy bodies a-synuclein aggregates
98
peak age onset of LBD
over 65yr
99
early signs of LBD
REM sleep behaviour disorder attention depression
100
LBD effects memory later than Alzheimer’s. T or F
T
101
later onset signs of LBD
visual hallucinations parkinsonism dementia
102
is LBD fluctuating or constantly progressive?
fluctuating
103
diagnostic criteria for LBD
fluctuating cognition + recurrent visual hallucinations +- extrapyramidal features
104
what abormality is found in CSF in LBD
a-synuclein
105
management options for LBD
small dose levodopa or rivastigmine
106
having a FH of what condition is a risk factor for pick's disease
MND
107
what is the pathology in pick's disease
extreme frontal lobe atrophy, then temporal
108
peak age range for pick's disease onset
50-60yr
109
early signs of pick's disease
``` behaviour/personality.. disinhibition apathy loss of insight lose empathy compulsive hyperorality etc. ```
110
later onset signs in pick's disease
intellect memory language speech
111
what is seen on mri in pick's disease
frontotemporal atrophy
112
management of pick's disease
trial trazadone or an antipsychotic
113
is amyloid normal in pick's disease
yes
114
csf abnormality in pick's disease
increase Tau protein

Y3 Neurology (23 decks)

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