Memory Loss Flashcards

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1
Q

What are the causes of memory loss

A

Normal-age related memory changes
Mild cognitive impairment (MCI)
Dementia
Depression
Delirium
Vitamin deficiency
Hypothyroidism
Adverse drug effects
Normal pressure hydrocephalus
Sensory deficits

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2
Q

What is the inheritance of Huntington’s disease

A

Autosomal dominant (50% chance)
HTT / huntingtin gene affected
Trinucleotide expansion disorder → genetic anticipation = onset and severity may be younger and greater in successive generations

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3
Q

Give examples of trinucleotide expansion disorders

A

Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
spinocerebellar ataxia
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy

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4
Q

What are the clinical features of Huntington’s disease

A

Movement – chorea, speech/swallowing, stumbling/clumsiness
Cognitive – organising tasks, flexibility, impulse control, learning new information, difficulty concentrating
Psychiatric – depression, irritability/mood swings, suicide in 9% of cases, personality change

Lack of insight
Chorea = involuntary jerking or fidgety movements that tend to flow from one area to another

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5
Q

Define Parkinson’s disease

A

PD = Neurodegenerative disease due to a severe loss in dopaminergic neurones in the substantia nigra

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6
Q

Define Parkinsonism

A

symptoms of Parkinson’s either in other diseases (Lewy body dementia) or as S/E of medication (DA antagonist)

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7
Q

What is Parkinson plus syndrome

A

Group of neurodegenerative diseases with Parkinsonism and additional features (not in idiopathic PD)

MSA - multiple system atrophy (Parkinson’s + autonomic systemic changes)
CBD - cortical bulbar degeneration (Parkinson’s + they believe to have an additional moving limb)
PSP - progressive supranucleic palsy (Parkinson’s + supranuclear gait palsy - impaired gaze, balance, dysarthria) - ophthalmoplegia

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8
Q

What is the aetiology of Parkinson’s disease

A

Usually idiopathic
Substantia nigra degeneration → dopamine deficiency in striatum → motor symptoms

Considered sporadic, although there are rare autosomal dominant and recessive forms
Genetic variants: SNCA, Parkin, PINK-1, DJ-1, TERM2, MHFTR, LRRK2

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9
Q

What are the risk factors for Parkinson’s disease

A

Increasing age
Male sex
History diet of familial PD in younger-onset disease
Mutation in gene encoding glucocerebrosidase
MPTP exposure
Chronic exposure to metals (manganese, iron)
Additional genetic risk factors
Head trauma
Geographic influence
Toxin exposure e.g. insecticides
Occupation as teacher, healthcare provider, construction worker, carpenter or cleaner

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10
Q

What are the symptoms of Parkinson’s disease

A

Cardinal symptoms:
→ Resting tremor (4-6Hz)
→ Rigidity (“Lead pipe”)
→ Bradykinesia
→ Postural instability

Other:
Masked facies/hypomimic face
Hypophonia
Hypokinetic dysarthria
Micrographia
Shuffling gait
Stooped posture
Conjugated gaze disorder
Fatigue
Constipation
Depression, anxiety
Dementia
REM sleep disorder: very active in sleep, vivid dreams

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11
Q

What is the UK PDS Brain Bank Criteria for PD

A
  1. Bradykinesia + one other cardinal symptom
  2. Exclusion criteria e.g. repeated strokes/head injury, antipsychotic use, encephalitis, more than one affected relative, neurological features
  3. supportive criteria (3 or more) e.g. unilateral, excellent response to levodopa, resting tremor
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12
Q

What are the signs of Parkinson’s disease on examination

A

Cogwheel rigidity
Shuffling gait, especially when turning a corner
Reduced arm swing
“Pill rolling” tremor
Masked facies (hypomimic face) - look at blinking
Hypophonia (reduced volume of voice)
Hypokinetic dysarthria
Micrographia
Stooped posture
Conjugated gaze disorder

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13
Q

What investigations should be done for Parkinson’s disease

A

Clinical diagnosis
+ dopaminergic agent trial

MRI brain:
- Normal in most patients
- Age-related changes e.g. small vessel disease acceptable
- Advanced disease - cortical atrophy, dorsolateral nigra hyperintensity

PET: Reduced basal ganglia pre-synaptic dopamine uptake

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14
Q

What is the management for Parkinson’s disease

A

Bio
First line: levodopa + carbidopa (DOPA-decarboxylase inhibitor)
Dyskinesia/motor fluctuations → dopamine agonists, MAO-B inhibitors or COMT inhibitors as an adjunct
Hallucinations: (1) review medication (2) quetiapine (3) clozapine
Dementia: cholinesterase inhibitors
Drooling: (1) SALT (2) glycopyrronium bromide (3) botulinum toxin A

Advanced disease: Deep brain stimulation: intermittent apomorphine injection and/or continuous SC apomorphine infusion

Social
Physiotherapy referral: assessment, education, advice
Alexander technique for balance or motor function problems
Occupational therapy
SALT (communications, swallowing, saliva)
Dietician referral

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15
Q

What are the side effects of levodopa

A

Increase risk of impulse control disorders: compulsive gambling, hypersexuality, binge eating, shopping
Nausea
Orthostatic hypotension
Excessive sleepiness → Consider modafinil to treat excessive daytime sleepiness
Hallucinations
Dyskinesias
Restless leg syndrome → consider clonazepam or melatonin
REM sleep disorder → consider clonazepam or melatonin
Nocturnal akinesia → consider levodopa or oral dopamine agonists

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