degenerative diseases of the CNS

Question 1

what are some common feature of neurodegenerative disease?

Answer 1

usually late onset
gradual progression
neuronal loss
structural imaging often normal

Question 2

what is dementia defined as?

Answer 2

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

Question 3

what are the most common causes of late onset dementia?(65+ yrs)

Answer 3

alzheimers (55%)
vascular (20%)
lewy body(20%)
others(others)

Question 4

what are the most common causes of young onset dementia? (<65 yrs)

Answer 4

alzheimers (33%)
vascular (15%)
frontotemporal (15%)
other (33%) (toxic, genetic, infection, inflammatory)

Question 5

what conditions can “mimic” dementia?

Answer 5

hydrocephalu
tumour
depression

Question 6

what are some treatable causes of dementia?

Answer 6

vitamin b12 deficiency
thyroid disease
HIV, syphilis

Question 7

what examinations would you perform to help diagnose dementia?

Answer 7

cognitive function
neurological
vascular

Question 8

what investigations are appropriate to help diagnose dementia?

Answer 8

bloods
CT/MRI
CSF
EEG

Question 9

what are the 2 screening tests used to assess cognitive function?

Answer 9

mini mental (MMSE)
montreal (MOCA)

Question 10

what type of dementia would a stepwise progression indicate?

Answer 10

vascular

Question 11

what would a rapid progression of dementia indicate?

Answer 11

creutzfeld jacob disease

Question 12

what are some other neurological signs that could help show the cause of dementia?

Answer 12

abnormal movements (huntingtons)
parkinsonism (lewy body)
myoclonus (CJD)

Question 13

what type of dementia is associated with alzheimers disease?

Answer 13

temporo-parietal dementia

Question 14

what are some features of temporo parietal dementia?

Answer 14

early memory disturbance
language and visuospatial problems
personality preserved until later

Question 15

what are some features of frontotemporal dementia?

Answer 15

early change in personality/behaviour
often change in eating habits
early dysphasia
memory/visuospatial relatively preserved

Question 16

what pharmacological treatments are used to treat alzheimers?

Answer 16

cholinesterase inhibitors
NMDA antagonist (memantine)

Question 17

what are some examples of cholinesterase inhibitors?

Answer 17

donepezil
rivastigmine
galantamine

Question 18

what features must a patient present with 2 or more of to be classed as having “parkinsonism”?

Answer 18

bradykinesia
rigidity
tremor
postural instability

Question 19

what is the pathology of parkinsonism?

Answer 19

loss of dopamine in the basal ganglia

Question 20

what causes parkinsonism?

Answer 20

idiopathic parkinsons disease
drug induced
vascular parkinsonism
parkinson plus syndromes

Question 21

what are some examples of parkinsons plus syndromes?

Answer 21

multiple system atrophy

progressive supranuclear palsy/corticobasal degeneration

Question 22

how is parkinsons disease diagnosed?

Answer 22

bradykinesia + 1 or more of: tremor, rigidity or postural intability
no other cause/atypical features
slowly progressive

Question 23

what does parkinsons disease have a good response to?

Answer 23

dopamine replacement treatment

Question 24

what imaging modality is useful for diagnosing/staging parkinsons disease?

Answer 24

dopamine transporter SPECT

Question 25

what are some examples of dopamine agonists?

Answer 25

ropinirole
pramipexole
rotigotine

Question 26

what is a drug used to convert tyrosine to dopamine?

Answer 26

levodopa

Question 27

what are some drug induced complications of parkinsons disease?

Answer 27

motor fluctuations - levodopa wears off
dyskinesias - involuntary movements
hallucinations

Question 28

what are some non drug induced complications of parkinsons?

Answer 28

depression
dementia
autonomic
speech, swallow
balance

Question 29

what drugs can prolong levodopas half life?

Answer 29

MAO-B inhibitors
COMT inhibitors
slow release levodopa