Cognitive Neurology Flashcards
What are the 6 cognitive domains?
- Attention
- Memory
- Visuospacial
- Language
- Social functioning
- Executive functioning
What is dementia diagnosis catagory?
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
What is an acute cognitive disorder?
A brain insult (deficit dependent on area of brain effected)
How does viral encephalitis effect cognition?
- Memory
- Behavior change
- Language
How does a head injury effect cognition?
- Attention
- Memory
- Executive dysfunction
How does a stroke effect cognition?
Dependent on area of brain effected
How does transient global amnesia present?
- Antegrade memory issues (repetitively asks the same questions)
- Transient 4-6hrs (always less than 24)
- Generally a once off episode
What age are transient global amnesia patients generally?
70’s
What are triggering factors for transient global amnesia?
emotion
changes in temperature
What kind of seizure is transient epileptic amnesia associated with?
Temporal lobe seizures
How does functional/subjective cognitive impairment present?
Decrease in concentration and forgetfulness
(i.e. going up stairs and forgetting why)
What is the most common prion disease?
CJD
What is prion disease?
Neurodegenerative proteinopathies
What is the mechanism of prion disease?
Prion protein misfolds and becomes toxic to the nerve cell
- Any misfolded prions make others misfold nearby
What are the 4 types of CJD and their general age of onset?
Sporadic - 60’s
Variant - 20’s
Iatrogenic - 30’s
Genetic - Any
What are key features of sporadic CJD?
Slow onset dementia
Neurological signs
Myoclonus
What are key features of variant CJD?
Painful sensory disturbance
Neuropsychiatric decline
What are key features of Iatrogenic CJD?
Cerebellar/Visual onset
Multifocal neurological decline
What are key features of genetic CJD?
Can mimic sporadic
Subtypes:
- GSS (prolonged ataxia)
- FFI (insomnia)
What is seen on post-mortem in all CJD patients?
Spongiform changes
What is the disease mechanism of Alzheimers?
Amyloid protein builds up and forms plaques as a result of synaptic loss and disruption of cholinergic pathways
What are the initial symptoms of Alzheimer’s?
Forgetfulness
What are some atypical presentations of Alzheimer’s?
Posterior cortical atrophy (posterior)
- Visuospatial disturbances
- Commonly present to ophthalmology
Progressive primary aphasia (anterior)
- Semantic (naming)
-Logopenic aphasia (repeating)
- Non-fluent aphasia (effortful)
What are some Alzheimer’s investigations?
- MRI: Atrophy of temporal/parietal lobes
- SPECT: reduced temporoparietal activity
How is Alzheimer’s treated?
Address vascular risk factors
Acetylcholine boosting treatment
- Cholinesterase inhibitors (e.g. rivastigmine/galantmine)
- NMDA receptor blocker (e.g. memantine)
What age are frontotemporal dementia patient normally?
<65
What is the most common presentation of frontotemporal dementia?
Behavioral variant of the disease
- Disinhibition
- Loss of empathy
- Compulsive behavior
- Early loss of insight
How does frontotemporal dementia show in MRI?
Atrophy of frontotemporal lobes
How is frontotemporal dementia treated?
Trial trazadone/antipsychotics to help behavioral issues
What age does vascular dementia normally present?
> 65
What criteria needs to be met for vascular dementia?
1) presence of cerebrovascular disease
2) Clear temporal relationship between cerebrovascular disease and dementia
How does vascular dementia present?
Reduced attention, Executive dysfunction, slowed processing
How is vascular dementia managed?
- Vascular risk factors
- Cholinesterase inhibitors
What general age are lewy-body dementia patients?
> 65
What are the core criteria for lewy body dementia?
1- Fluctuating cognition
2- Visual hallucinations
3- extrapyramidal features
What investigations are used for lewy-body dementia?
DaT (dopamine transporter imaging)
How is lewy-body dementia treated?
- Small dose levodopa
- Trial cholinesterase inhibitor
When does Huntington’s disease present?
30-50
How does Huntington’s present?
- Dysexecutive syndrome
- Slowed speed of processing
- Eventual memory involvement
How is Huntington’s disease treated?
- Mood stabalisers
- Treat chorea
What is the most common bedside test of cognition?
Addenbrookes test
What does Addenbrookes test look for?
- Attention
- Memory
- Fluency (language)
- Visuospatial
