Cognitive Neurology Flashcards
what are the three criteria for a diagnosis of a dementia?
evidence of significant
cognitive decline
deficits interfere with everyday activities
not better explained by another process
what is the main clinical feature of transient global amnesia?
abrupt onset amnesia
anterograde more commonly than retrograde
how long does a transient global amnesia last?
4-6 hours usually
always under 24
what age group is affected by transient global amnesia?
> 50’s
what factors could possible trigger a transient global amnesia?
emotion
changes in temperature
what are the clinical features of transient epileptic amnesia?
forgetful, repetitive questioning
short lived
what more serious symptom are transient epileptic amnesias associated with?
temporal lobe seizures
what drugs do transient epileptic amnesias respond to?
anti epileptic medications
what are the clinical features of a functional cognitive impairment?
everyday forgetfulness impacting on function
fluctuating symptoms
name the most common prion disease
Creutzfeldt-Jakob disease
what is the pathophysiology behind Creutzfeldt-Jakob disease?
prion protein becomes misfolded and can’t be broken down and causes neurodegeneration
one misfolded causes a domino effect - changes all it touches
how is Creutzfeldt-Jakob disease diagnosed?
biomarkers
MRI C
CSF tests
what can be seen histologically in Creutzfeldt-Jakob disease?
spongiform change later on
what mediates limbic encephalitis?
inflammation and antibodies
how does limbic encephalitis present?
short term memory deficits
seizures
behavioural changes
what is seen on MRI and CSF in limbic encephalitis?
inflammatory changes
antibodies in CSF
what can limbic encephalitis be associated with?
underlying autoimmune disease or malignancy
how is limbic encephalitis managed?
treat underlying cause
immunosuppression
what histopathological features are seen in Alzheimer’s disease?
extracellular amyloid plaques
intracellular neurofibrillary tangles
what effect do extracellular amyloid plaques have in Alzheimer’s disease?
disrupt normal cell function
induces apoptosis
what effect do intracellular neurofibrillary tangles have in Alzheimer’s disease?
disrupt the cytoskeleton leading to cell death
what is the initial symptom of Alzheimer’s disease?
general forgetfulness
what does degeneration of the hippocampus and parietal lobes in Alzheimer’s disease lead to?
apraxia
visuospatial difficulties
what is early onset Alzheimer’s disease?
Alzheimer’s disease in people under 65
often associated with genetic influences
what is sporadic Alzheimer’s disease?
Alzheimer’s disease in people over 65
name two atypical presentations of Alzheimer’s disease
posterior cortical atrophy
progressive primary aphasia
how does posterior cortical atrophy present?
visuospatial disturbance
often referred from ophthalmology
how does progressive primary aphasia present?
language dominant symptoms initially
followed by further cognitive decline
name three types of progressive primary aphasia and the language issue associated
semantic - naming
logogenic - repeating
non fluent - effortful
what four investigations can be done for Alzheimer’s disease?
MRI
SPECT
CSF
amyloid ligand imaging
what is seen on MRI in Alzheimer’s disease?
atrophy of temporal/parietal lobes
what is seen on SPECT in Alzheimer’s disease?
temperoparietal metabolism decreased
what is seen in CSF in Alzheimer’s disease?
decreased amyloid: increased tau ratio
what is the management of Alzheimer’s disease?
manage vascular risk factors
acetylcholine boosting treatments
what two acetylcholine boosting treatments are available for Alzheimer’s disease?
cholinesterase inhibitors
NMDA receptor blocker
name two cholinesterase inhibitors that can be used for Alzheimer’s disease
rivastigmine
galantamine
name an NMDA receptor blocker that can be used for Alzheimer’s disease
memantine
when does frontotemporal dementia come on?
early onset - usually <65
what is the pathophysiology behind frontotemporal dementia?
protein aggregation leads to cell damage, resulting in neurodegeneration
what three investigations may be done for frontotemporal dementia?
MRI
SPECT
CSF
what is seen in MRI in frontotemporal dementia?
atrophy of the fronts-temporal lobes
what is seen on SPECT in frontotemporal dementia?
reduced frontotemporal metabolism
what is seen in CSF in frontotemporal dementia?
increased tau
normal amyloid
what is the management of frontotemporal dementia?
trial of trazodone or anti-psychotics to help behavioural features
what safety management should be implemented in frontotemporal dementia?
controlled access to things like food, money and the internet
structured activities
what legal consideration needs to be thought about in frontotemporal dementia?
power of attorney for future choices
when does vascular dementia come on?
late onset - majority of patients are over 65
what are the two core criteria for a diagnosis of vascular dementia?
presence of cerebrovascular disease
a clear temporal relationship between the onset of dementia and the cerebrovascular disease
how does vascular dementia present?
reduced attention
executive dysfunction
slowed processing
how is vascular dementia managed?
manage vascular risk factors
cholinesterase inhibitor
when does dementia with Lewy bodies come on?
late onset - majority >65
what are the core criteria for the diagnosis of dementia with Lewy bodies?
fluctuating cognition
recurrent well formed visual hallucinations
+/- presence of extra pyramidal features
what investigations are done for dementia with Lewy bodies?
none really - a clinical diagnosis
how is dementia with Lewy bodies managed?
small dose levodopa
trial cholinesterase inhibitors
when does Parkinson’s disease dementia come on?
late onset, most >65
usually after 20 years of having Parkinson’s
how does Parkinson’s disease dementia present?
symptoms of Parkinson’s
dementia
may have hallucinations
when do symptoms of Huntington’s come on?
30-50
what causes Huntington’s?
expansion of the CAG trinucleotide repeat in the huntingtin mean = produces a neurodegenerative protein
what is seen on MRI in Huntington’s?
loss of caudate heads
where is a patient >65 with gradual onset dementia and no additional neurology referred to?
old age psychiatry
where is someone <65 or with any unusual features of additional neurology referred to?
neurology
