Intro to neuropsychiatry Flashcards
What symptoms in dementia are generally considered to be the major source of caregiver stress?
Neuropsychiatric symptoms / BPSD
What lobes in Alzheimer’s are most commonly attacked first?
Temporal and parietal lobes
What is the characteristic sign of Lewy Body dementia that differentiates it from Alzheimer’s?
- Well formed visual hallucinations
- Systematised dellusions (very detailed and well formed)
What features are essential for a diagnosis of Lewy body dementia?
2 of these 3:
- Fluctuating cognition with pronounced variations in attention and alertness
- Recurrent visual hallucinations well formed and detailed
- Spontaneous motor features of parkinsonism
A diagnosis of Lewy Body dementia is less likely in the presence of what?
- Stroke disease, evidnet as focal neurological signs or brain damage
- Evidence on physical examination and investigation of any physical illness or other brain disorder sufficient to account for the clinical picture
What symptoms are associated with Alzheimer’s?
- Plateaus in the course of progression of the illness
- Associated symptoms of:
- Depression
- Insomnia
- Incontinance
- Dellusions
- Illusions
- Hallucinations
- Catastrophic verbal, emotional, or physical outbursts
- Sexual disorders
- Weight loss
What are features of Alzheimer’s that make the diagnosis uncertain or unlikely?
- Sudden, apoplectic onset
- Focal neurological findings such as hemiparesis, sensory loss, visual field deficits, and incoordination early in the course of the illness
- Seizures or gait disturbances at the onset or very early in the course of the illness
What are the central features required for a diagnosis of Lewy Body Dementia?
- Progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function
- Prominent or persistent memory impairment may not necessarily occur in the early stages but is usually evident with progression
- Deficits on tests of attention and of frontal subcortical skills may be especially prominent
What disease is highly corolated with Lewy Body dementia?
Parkinson’s
What is the difference between Parkinson’s or Lewy Body dementia?
- Parkinson’s patients present with motor symptoms first which then progress to parkinson’s dementia.
- More pronounced cortical atrophy, elevated cortical and limbic in Lewy body pathologies
- Higher A beta and tau loads in cortex and striatum in Lewy body compared to Parkinson’s
What symptoms does fronto-temporal dementia present with?
- Speech
- Behavioural symptoms associated with frontal lobe damage (early loss of social awareness, hygiene, unrestrained sexuality, hyprorality, impulsiveness, early loss of insight into the fact that the altered conditions are due to pathological changes)
- Depression, anxiety, excessive sentimentality, suicidal and fixed ideation, delusion
- Hypochondriasis, bizarre somatic preoccupation
- Emotional unconcern (emotional indifference and remoteness, lack of empathy)
- Amimia
What dementia is the patient generally thought to have when unable to diagnose any other dementia?
Vascular dementia
What is pseudobulbar palsy?
Personality and mood changes but are disconnected to facial muscles (e.g laughing whilst being upset and telling a sad story)
- Often seen in vascular dementia
What percentage of Motor neuron disease patients have major depressive disorder?
~ 50% (likely to reflect cortical damage, not just reaction to disability)
What can Motor neuron disease cause?
- Mania - e.g oribitofrontal prefrontal cortex-impulsivity, mood lability, personality changes seen in mania
- Pseudobulbar affect - disconnect between mood and affect
- Psychosis 2-3x more common in MS patients compared to general population e.g medial temporal damage
