Degenerative Disorders

Question 1

define Alzheimer’s Disease

Answer 1

a chronic and progressive degenerative condition of the brain leading to memory loss and global impairment of brain function

Question 2

characteristics of Alzheimer’s Disease (AD)

Answer 2

cerebral atrophy
amyloid plaques
tau protein tangles

Question 3

clinical features of AD

Answer 3

recent memory loss (amnesia)
aphasia (word finding problem + muddled speech)
agnosia (recognition problems)
apraxia (inability to carry out skilled tasks)

Question 4

investigations of AD

Answer 4

bloods (FBC, ESR/CRP, U+Es, HbA1c, LFTs, TFTs, serum B12 and folate)
cognitive assessment tool
CT brain

Question 5

conservative management of AD

Answer 5

cognitive stimulation therapy

group reminisence therapy

Question 6

medical management of AD

Answer 6

AChE inhibitors (e.g. donepezil)
N-methyl-D-aspartic acid antagonist (e.g. memantine)
antipsychotics (e.g. risperidone)
antidepressants

Question 7

define Lewy Bodies dementia

Answer 7

a progressive, complex and

Question 8

risk factors of dementia

Answer 8

age 
mild cognitive impairment 
genetics (PSEN1 or PSEN2) 
MH of CVD, cerebrovascular disease or hypertension 
depression 
smoking

Question 9

characteristics of Lewy Body dementia

Answer 9

alpha-synuclein cytoplasmic inclusions (Lewy Bodies) within substantia nigra, paralimbic and neocortical areas

Question 10

clinical features of Lewy Body dementia

Answer 10

fluctuating cognition
progressive cognitive impairment
parkinsonism
visual hallucinations

Question 11

define frontotemporal dementia

Answer 11

a dementia caused by the atrophy of the frontal and temporal lobes

Question 12

clinical features of frontotemporal dementia

Answer 12

younger age presentation

personality change and development of disinhibition

Question 13

cause of frontemporal dementia

Answer 13

Pick’s Disease - accumulations of TAU protein within neurons of the frontal and temporal lobes

Question 14

management of frontotemporal dementia

Answer 14

referral to psychiatry and organised social support

Question 15

define vasculature dementia

Answer 15

dementia caused by impaired blood flow to areas of the brain due to vascular damage - often occurs following ischaemic or haemorrhagic insults to brain

Question 16

define Parkinson’s Disease (PD)

Answer 16

a neurodegenerative disorders occurring due to degeneration of dopaminergic neurones within the substantia nigra

Question 17

clinical features of PD

Answer 17

bradykinesia 
asymmetric 'pill rolling' tremor 
cogwheeling (jerking rigidity of tone)
shall shuffling gait 
slowness of movement and flexed posture

Question 18

non-motor features of PD

Answer 18

constipation 
postural hypotension
erectile dysfunction
olfactory loss 
depression + anxiety

Question 19

medical management of PD

Answer 19

levodopa + carbidopa
dopamine agonist (cabergoline)
monoamine oxidase inhibitors
COMT inhibitors

Question 20

common side effects of levodopa

Answer 20

hypotension
restlessness
GI upset
acute psychosis (rare)

Question 21

define normal pressure hydrocephalus

Answer 21

a reversible cause of dementia arising due to impaired absorption of CSF

Question 22

triggers of normal pressure hydrocephalus

Answer 22

insult to the head/brain (e.g. trauma or bleed)

Question 23

clinical features of normal pressure hydrocephalus

Answer 23

urinary incontinence
dementia
gait abnormality
(wet, wacky and wobbly)

Question 24

management of normal pressure hydrocephalus

Answer 24

ventriculo-peritoneal shunting OR repeated CSF taps