Degenerative diseases of the central nervous system

Question 1

Define dementia

Answer 1

A syndrome consisting of progressive impairment of multiple domains of cognitive function in an alert patient leading to loss of acquired skills and interference in occupational and social role

Question 2

What is the age cut off between early and late onset dementia?

Answer 2

65

Question 3

4 causes of late onset dementia

Answer 3

alzheimers
Lewy bodies
vascular
other

Question 4

4 causes of early onset dementia

Answer 4

Alzheimers
frontotemporal
vascular
other

Question 5

The “other” causes of dementia

Answer 5

infective eg HIV, CJD
inflammatory eg MS
Toxic eg alcohol
genetic eg huntingtons

Question 6

List some treatable causes or mimics of dementia

Answer 6

infective eg HIV, syphilis 
Endocrine eg thyroid disease 
Vitamin deficiency eg B12 
hydrocephalus 
tumour 
depression

Question 7

What is important in a history taking with suspected dementia?

Answer 7

rate of progression, onset, defecit type, risk factors, FH

Question 8

Examination of dementia

Answer 8

vascular, neurological, cognitive function

Question 9

Investigations of suspected dementia

Answer 9

routine eg bloods, CT/MRI

others eg CSF, EEG, biopsy, functional imaging and genetics

Question 10

List some domains of cognitive function to examine

Answer 10

memory, attention, agnosias, apraxias, visuospatial, behavioural, executive function

Question 11

Screening tests for dementia

Answer 11

MMSE, montreal MOCA

Question 12

Clues of progression of dementia - rapid? stepwise?

Answer 12

rapid - CJD

stepwise - vascular

Question 13

Other neurological signs clues with dementia - abnormal movements? parkinsonism? myoclonus?

Answer 13

huntingtons
lewy bodies
CJD

Question 14

Mean age onset of parkinsonism

Answer 14

70

Question 15

Does tempero-parietal or fronto-temporal dementia show an early change in personality/behaviour?

Answer 15

fronto-temporal

Question 16

Non pharmacological symptomatic treatment of dementia

Answer 16

support and information
dementia services
OT, social work, respite, placement
voluntary organisations

Question 17

Pharmacological treatment of symptoms of dementia

Answer 17

insomnia
depression
behaviour

Question 18

Specific treatment for alzheimers with or without lewy body dementia

Answer 18

cholinesterase inhibitors

NMDA antagonist

Question 19

Define parkinsonism

Answer 19

A clinical syndrome consisting of 2 or more of bradykinesia, tremor, rigidity and postural instability

Question 20

What chemical is lost in parkinson’s and why?

Answer 20

dopamine

basal ganglia

Question 21

List some causes of parkinsons

Answer 21

idiopathic - dementia with lewy bodies
drug induced eg dopamine antagonists
vascular
progressive supranuclear palsy

Question 22

Are men or women more likely to get parkinsons?

Answer 22

men - 1.5 times

Question 23

Prognosis of parkinsons?

Answer 23

60-90% disabled or dead at 10 years

Question 24

2 things to support a parkinsons diagnosis

Answer 24

asymmetry of tremor

good response to treatment

Question 25

Functional imaging of parkinsons

Answer 25

dopamine transporter SPECT

Question 26

List some treatments of parkinsons

Answer 26

dopamine agonist
MAO-B inhibitor
COMT inhibitor

Question 27

Drug induced complications with parkinsons

Answer 27

motor fluctuations
dyskinesias
psychiatric

Question 28

Non drug induced complications of parkinsons

Answer 28

depression 
dementia 
autonomic eg BP, bladder and bowel 
speech, swallow 
balance

Question 29

Late treatments of Parkinson’s (and aim)

Answer 29

prolong levodopa half life 
slow release levodopa 
COMP inhibitor 
MOA-B inhibitor 
oral dopamine agonist 
functional neurosurgery 
allied health professionals