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Y3 Neurology > Cognitive Neurology > Flashcards

Cognitive Neurology Flashcards

1
Q

what are the three criteria for a diagnosis of a dementia?

A

evidence of significant
cognitive decline

deficits interfere with everyday activities

not better explained by another process

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2
Q

what is the main clinical feature of transient global amnesia?

A

abrupt onset amnesia

anterograde more commonly than retrograde

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3
Q

how long does a transient global amnesia last?

A

4-6 hours usually

always under 24

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4
Q

what age group is affected by transient global amnesia?

A

> 50’s

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5
Q

what factors could possible trigger a transient global amnesia?

A

emotion

changes in temperature

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6
Q

what are the clinical features of transient epileptic amnesia?

A

forgetful, repetitive questioning

short lived

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7
Q

what more serious symptom are transient epileptic amnesias associated with?

A

temporal lobe seizures

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8
Q

what drugs do transient epileptic amnesias respond to?

A

anti epileptic medications

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9
Q

what are the clinical features of a functional cognitive impairment?

A

everyday forgetfulness impacting on function

fluctuating symptoms

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10
Q

name the most common prion disease

A

Creutzfeldt-Jakob disease

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11
Q

what is the pathophysiology behind Creutzfeldt-Jakob disease?

A

prion protein becomes misfolded and can’t be broken down and causes neurodegeneration

one misfolded causes a domino effect - changes all it touches

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12
Q

how is Creutzfeldt-Jakob disease diagnosed?

A

biomarkers
MRI C
CSF tests

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13
Q

what can be seen histologically in Creutzfeldt-Jakob disease?

A

spongiform change later on

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14
Q

what mediates limbic encephalitis?

A

inflammation and antibodies

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15
Q

how does limbic encephalitis present?

A

short term memory deficits
seizures
behavioural changes

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16
Q

what is seen on MRI and CSF in limbic encephalitis?

A

inflammatory changes

antibodies in CSF

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17
Q

what can limbic encephalitis be associated with?

A

underlying autoimmune disease or malignancy

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18
Q

how is limbic encephalitis managed?

A

treat underlying cause

immunosuppression

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19
Q

what histopathological features are seen in Alzheimer’s disease?

A

extracellular amyloid plaques

intracellular neurofibrillary tangles

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20
Q

what effect do extracellular amyloid plaques have in Alzheimer’s disease?

A

disrupt normal cell function

induces apoptosis

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21
Q

what effect do intracellular neurofibrillary tangles have in Alzheimer’s disease?

A

disrupt the cytoskeleton leading to cell death

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22
Q

what is the initial symptom of Alzheimer’s disease?

A

general forgetfulness

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23
Q

what does degeneration of the hippocampus and parietal lobes in Alzheimer’s disease lead to?

A

apraxia

visuospatial difficulties

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24
Q

what is early onset Alzheimer’s disease?

A

Alzheimer’s disease in people under 65

often associated with genetic influences

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25
Q

what is sporadic Alzheimer’s disease?

A

Alzheimer’s disease in people over 65

26
Q

name two atypical presentations of Alzheimer’s disease

A

posterior cortical atrophy

progressive primary aphasia

27
Q

how does posterior cortical atrophy present?

A

visuospatial disturbance

often referred from ophthalmology

28
Q

how does progressive primary aphasia present?

A

language dominant symptoms initially

followed by further cognitive decline

29
Q

name three types of progressive primary aphasia and the language issue associated

A

semantic - naming
logogenic - repeating
non fluent - effortful

30
Q

what four investigations can be done for Alzheimer’s disease?

A

MRI
SPECT
CSF
amyloid ligand imaging

31
Q

what is seen on MRI in Alzheimer’s disease?

A

atrophy of temporal/parietal lobes

32
Q

what is seen on SPECT in Alzheimer’s disease?

A

temperoparietal metabolism decreased

33
Q

what is seen in CSF in Alzheimer’s disease?

A

decreased amyloid: increased tau ratio

34
Q

what is the management of Alzheimer’s disease?

A

manage vascular risk factors

acetylcholine boosting treatments

35
Q

what two acetylcholine boosting treatments are available for Alzheimer’s disease?

A

cholinesterase inhibitors

NMDA receptor blocker

36
Q

name two cholinesterase inhibitors that can be used for Alzheimer’s disease

A

rivastigmine

galantamine

37
Q

name an NMDA receptor blocker that can be used for Alzheimer’s disease

A

memantine

38
Q

when does frontotemporal dementia come on?

A

early onset - usually <65

39
Q

what is the pathophysiology behind frontotemporal dementia?

A

protein aggregation leads to cell damage, resulting in neurodegeneration

40
Q

what three investigations may be done for frontotemporal dementia?

A

MRI
SPECT
CSF

41
Q

what is seen in MRI in frontotemporal dementia?

A

atrophy of the fronts-temporal lobes

42
Q

what is seen on SPECT in frontotemporal dementia?

A

reduced frontotemporal metabolism

43
Q

what is seen in CSF in frontotemporal dementia?

A

increased tau

normal amyloid

44
Q

what is the management of frontotemporal dementia?

A

trial of trazodone or anti-psychotics to help behavioural features

45
Q

what safety management should be implemented in frontotemporal dementia?

A

controlled access to things like food, money and the internet

structured activities

46
Q

what legal consideration needs to be thought about in frontotemporal dementia?

A

power of attorney for future choices

47
Q

when does vascular dementia come on?

A

late onset - majority of patients are over 65

48
Q

what are the two core criteria for a diagnosis of vascular dementia?

A

presence of cerebrovascular disease

a clear temporal relationship between the onset of dementia and the cerebrovascular disease

49
Q

how does vascular dementia present?

A

reduced attention
executive dysfunction
slowed processing

50
Q

how is vascular dementia managed?

A

manage vascular risk factors

cholinesterase inhibitor

51
Q

when does dementia with Lewy bodies come on?

A

late onset - majority >65

52
Q

what are the core criteria for the diagnosis of dementia with Lewy bodies?

A

fluctuating cognition

recurrent well formed visual hallucinations

+/- presence of extra pyramidal features

53
Q

what investigations are done for dementia with Lewy bodies?

A

none really - a clinical diagnosis

54
Q

how is dementia with Lewy bodies managed?

A

small dose levodopa

trial cholinesterase inhibitors

55
Q

when does Parkinson’s disease dementia come on?

A

late onset, most >65

usually after 20 years of having Parkinson’s

56
Q

how does Parkinson’s disease dementia present?

A

symptoms of Parkinson’s
dementia
may have hallucinations

57
Q

when do symptoms of Huntington’s come on?

A

30-50

58
Q

what causes Huntington’s?

A

expansion of the CAG trinucleotide repeat in the huntingtin mean = produces a neurodegenerative protein

59
Q

what is seen on MRI in Huntington’s?

A

loss of caudate heads

60
Q

where is a patient >65 with gradual onset dementia and no additional neurology referred to?

A

old age psychiatry

61
Q

where is someone <65 or with any unusual features of additional neurology referred to?

A

neurology

Y3 Neurology (31 decks)

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