Dementia and disorders of equilibrium and vision

Question 1

What is dementia

Answer 1

syndrome that involves chronic impairment of multiple higher cortical functions such as memory, thinking, orientation, comprehension, and language.

Question 2

Causes of dementia

Answer 2

Alzheimers
Vascular - e.g. from strokes
Parkinson’s association
Dementia with lewy bodies
Chronic alcohol abuse

Question 3

What is alzheimer’s

Answer 3

Slowly progressive memory loss and other cognitive decline

• neurofibrillary tangles, neurotic plaques and cerebral atrophy in brain

Question 4

Sx of alzheimer’s disease

Answer 4

Progressive memory loss despite being alert
Inattention
Inability to problem solve
Language difficulties
Sundowning - worse at night
Personality changes

Question 5

Alzheimer’s disease diagnosis

Answer 5

Clinical diagnosis

If in psychiatry service - may do MRI / PET to see brain atrophy / amyloid plaques

Question 6

Alzheimer disease medications

Answer 6

Acetylcholine esterase inhibitors e.g. donepezil, alantamine, rivastigmine

Memory clinic
Caregiver support
Physical and occupational therapy
- low prognosis

Question 7

RF for strokes

Answer 7

HTN
Hypercholesterolaemia
Family history of cerebral vascular disease
Diabetes
Smoking
Atrial fibrillation

Question 8

Diagnosis of vascular dementia

Answer 8

acute onset of symptoms followed by vascular event e.g. stroke
MRI - to look for signs of stroke
Blood tests - cholesterol

Question 9

Vascular dementia treatment

Answer 9

Future stroke prevention
Manage blood pressure, glucose and cholesterol levels to prevent strokes
Physical and occupational therapy

Question 10

Types of mild cognitive impairment

Answer 10

Amnestic
Non amnestic

Question 11

Diagnosing mild cognitive impairment

Answer 11

History and family history
MMSE

Question 12

Mild cognitive impairment treatment

Answer 12

No treatment

May go onto develop alzheimers dementia
PREVENTION OF PROGRESSION

Smoking and alcohol cessation
Control BP, glucose and cholesterol
Diet high in omega 3 fatty acids
Keep mentally active e.g. reading, puzzles etc…

Question 13

RF for blow induced dementia

Answer 13

Footbal players - heading the ball
Bowers
Domestic vioelence survivors with repeated head trauma

Question 14

Blow induced dementia treatmet

Answer 14

No treatment only prevention
Wear helmet

Treat concussion if present

Question 15

What is normal pressure hydrocephalus!!!

Answer 15

Classic triad - dementia, gait disturbance, urinary incontinence

Question 16

Clinical signs of normal pressure hydrocephalus

Answer 16

Gait
Urinary incontinence
Cognitive disturbance - low attention, low concentration, apathetic, depressed

Question 17

Ix for normal pressure hydrocephalus

Answer 17

MRI of head
LP to test clinical response to removal of CSF (testing if it goes back to baseline level and return of cognitive function)
Neuro referral for more Ix

Question 18

Normal pressure hydrocephalus treatment

Answer 18

Ventricular shunt placement

Question 19

What is frontotemporal dementia

Answer 19

Rare cause of dementia causing extreme inappropriate behaviour

Question 20

Huntington disease presentation, investigations and treatment

Answer 20

Inherited disease - onset from 35-45
Progressive irregular sudden muscle movements
Dementia
Bursts of anger
Antisocial behaviour

History taking and genetic testing

Symptmatic treatment - fatal in 15-20 yrs

Question 21

Presentation and treatment of creutzfeldt-jakob disease aka bovine spongiform encephalitis

Answer 21

Abnormalities in all parts of neurologic symptoms

Rare fatal cause of dementia - no treatment - only symptomatic management

Question 22

Difference in “dizziness” between BPPV, orthostasis or vertigo

Answer 22

Hearing diminished (BPPV)
Vertigo
Lightheaded on standing up (orthostasis)

Question 23

Causes of peripheral vertigo

Answer 23

BPPV
Otitis media
Labrynthitis
Vestibular neuronitis
Foreigh body or wax in ear
Acoustic neuroma
Motion sickness

Question 24

Causes of central vertigo

Answer 24

Stroke
Temporal lobe epilepsy
Tmour
Post concussion
Vertebral artery insufficiency
Basilar artery migraine

Question 25

Symptom difference between peripheral and central vertigo

Answer 25

Peripheral
- sudden
- severe
- lasts minute
- intermittent
- horizontal nystagmus
- worse in certain positions
- no neuro findings
- reduced hearing
- tinnitus

Central
- gradual onset
- mild
- lasts hours/days
- multidirectional nystagmus
- not worse in certain positions
- neuro findings
- normal hearing

Question 26

Symptoms, diagnosis and treatment of BPPV (benign paroxysmal positional vertigo)

Answer 26

Peripheral vertigo symptoms
- worse on rolling over in bed

History
Absence of neuro findings
Horizontal nystagmus

Tx - Head maneuvers to resposition or betahistine

Question 27

What is Dix - Hallpike maneuver

Answer 27

Check for nystagmus

Sit upright with legs extended and rotate head 45 degrees then lie them down with head extended at 20 degrees

Observe for 45 seconds

Don’t do if neck problems
If vertical nystagmus seen = CNS abnormality

Question 28

Sx of pseudotumor cerebrii

Answer 28

Headache - worse over time
Diplopia
Visual disturbance and flashes of light
Hearing pulsations inside head

Question 29

Ix for pseudotumour cerebrii

Answer 29

Physical exam - PAPILLOEDEMA, decreased visual acuity, cranial nerve VI palsy, obesity

CT - rule out brain tumour
Lumbar puncure after ruling out mass in brain - visual symptoms may improve whilst taking CSF

Question 30

Pseudomotor cerebrii management

Answer 30

Agressive weight loss
Sodium restriction
Carbonic anhydrase inhibitor e.g. acetazolamide (decrease rate of CSF production)

Diuretics
Shunting or serial lumbar punctures