Cognitive Neurology

Question 1

What are the 6 cognitive domains?

Answer 1

• Attention
• Memory
• Visuospacial
• Language
• Social functioning
• Executive functioning

Question 2

What is dementia diagnosis catagory?

Answer 2

Evidence of significant cognitive decline in at least 1 cognitive domain
+ Deficit interferes with independence in every day activities
+ Deficit is not better explained by another process

Question 3

What is an acute cognitive disorder?

Answer 3

A brain insult (deficit dependent on area of brain effected)

Question 4

How does viral encephalitis effect cognition?

Answer 4

• Memory
• Behavior change
• Language

Question 5

How does a head injury effect cognition?

Answer 5

• Attention
• Memory
• Executive dysfunction

Question 6

How does a stroke effect cognition?

Answer 6

Dependent on area of brain effected

Question 7

How does transient global amnesia present?

Answer 7

• Antegrade memory issues (repetitively asks the same questions)
• Transient 4-6hrs (always less than 24)
• Generally a once off episode

Question 8

What age are transient global amnesia patients generally?

Answer 8

70’s

Question 9

What are triggering factors for transient global amnesia?

Answer 9

emotion
changes in temperature

Question 10

What kind of seizure is transient epileptic amnesia associated with?

Answer 10

Temporal lobe seizures

Question 11

How does functional/subjective cognitive impairment present?

Answer 11

Decrease in concentration and forgetfulness
(i.e. going up stairs and forgetting why)

Question 12

What is the most common prion disease?

Answer 12

CJD

Question 13

What is prion disease?

Answer 13

Neurodegenerative proteinopathies

Question 14

What is the mechanism of prion disease?

Answer 14

Prion protein misfolds and becomes toxic to the nerve cell
- Any misfolded prions make others misfold nearby

Question 15

What are the 4 types of CJD and their general age of onset?

Answer 15

Sporadic - 60’s
Variant - 20’s
Iatrogenic - 30’s
Genetic - Any

Question 16

What are key features of sporadic CJD?

Answer 16

Slow onset dementia
Neurological signs
Myoclonus

Question 17

What are key features of variant CJD?

Answer 17

Painful sensory disturbance
Neuropsychiatric decline

Question 18

What are key features of Iatrogenic CJD?

Answer 18

Cerebellar/Visual onset
Multifocal neurological decline

Question 19

What are key features of genetic CJD?

Answer 19

Can mimic sporadic
Subtypes:
- GSS (prolonged ataxia)
- FFI (insomnia)

Question 20

What is seen on post-mortem in all CJD patients?

Answer 20

Spongiform changes

Question 21

What is the disease mechanism of Alzheimers?

Answer 21

Amyloid protein builds up and forms plaques as a result of synaptic loss and disruption of cholinergic pathways

Question 22

What are the initial symptoms of Alzheimer’s?

Answer 22

Forgetfulness

Question 23

What are some atypical presentations of Alzheimer’s?

Answer 23

Posterior cortical atrophy (posterior)
- Visuospatial disturbances
- Commonly present to ophthalmology

Progressive primary aphasia (anterior)
- Semantic (naming)
-Logopenic aphasia (repeating)
- Non-fluent aphasia (effortful)

Question 24

What are some Alzheimer’s investigations?

Answer 24

• MRI: Atrophy of temporal/parietal lobes
• SPECT: reduced temporoparietal activity

Question 25

How is Alzheimer's treated?

Answer 25

Address vascular risk factors Acetylcholine boosting treatment - Cholinesterase inhibitors (e.g. rivastigmine/galantmine) - NMDA receptor blocker (e.g. memantine)

Question 26

What age are frontotemporal dementia patient normally?

Answer 26

<65

Question 27

What is the most common presentation of frontotemporal dementia?

Answer 27

Behavioral variant of the disease - Disinhibition - Loss of empathy - Compulsive behavior - Early loss of insight

Question 28

How does frontotemporal dementia show in MRI?

Answer 28

Atrophy of frontotemporal lobes

Question 29

How is frontotemporal dementia treated?

Answer 29

Trial trazadone/antipsychotics to help behavioral issues

Question 30

What age does vascular dementia normally present?

Answer 30

>65

Question 31

What criteria needs to be met for vascular dementia?

Answer 31

1) presence of cerebrovascular disease 2) Clear temporal relationship between cerebrovascular disease and dementia

Question 32

How does vascular dementia present?

Answer 32

Reduced attention, Executive dysfunction, slowed processing

Question 33

How is vascular dementia managed?

Answer 33

- Vascular risk factors - Cholinesterase inhibitors

Question 34

What general age are lewy-body dementia patients?

Answer 34

>65

Question 35

What are the core criteria for lewy body dementia?

Answer 35

1- Fluctuating cognition 2- Visual hallucinations 3- extrapyramidal features

Question 36

What investigations are used for lewy-body dementia?

Answer 36

DaT (dopamine transporter imaging)

Question 37

How is lewy-body dementia treated?

Answer 37

- Small dose levodopa - Trial cholinesterase inhibitor

Question 38

When does Huntington's disease present?

Answer 38

30-50

Question 39

How does Huntington's present?

Answer 39

- Dysexecutive syndrome - Slowed speed of processing - Eventual memory involvement

Question 40

How is Huntington's disease treated?

Answer 40

- Mood stabalisers - Treat chorea

Question 41

What is the most common bedside test of cognition?

Answer 41

Addenbrookes test

Question 42

What does Addenbrookes test look for?

Answer 42

- Attention - Memory - Fluency (language) - Visuospatial