Neuro and geriatrics

Question 1

What is the DCML and what is its function?

Answer 1

Dorsal column-medial lemniscus (DCML)
info about fine touch, vibration sense, and proprioception which is transported in dorsal column in the posterior section of the spinal cord
two regions: Fasciculus gracilis and Fasciculus cuneatus

Question 2

Which tract carries information for fine touch, vibration sense, and proprioception?

Answer 2

Dorsal column-medial lemniscus (DCML)

Question 3

Where do fibres in DCML decussate?

Answer 3

fibres remain ipsilateral until they decussate in the medulla

Question 4

triad for parkinsons and their key aspects/examples?

Answer 4

resting tremor - unilateral, pill rolling tremor
bradykinesia - movements get slower and smaller eg. shuffling gait, small handwriting, turning around, facial expression
rigidity - cogwheel rigidity aka movement in small increments/small jerks

Question 5

treatment for parkinsons?

Answer 5

levodopa - synthetic dopamine taken with a peripheral decarboxylase inhibitor
COMT inhibitor - stops the COMT enzyme which metabolises levodopa in body and brain
Dopamine agonists -

Question 6

what is levodopa taken with and why? give an example

Answer 6

a peripheral decarboxylase inhibitor because this stops it from being broken down in the body before it reaches the brain
eg. co-benyldopa (levodopa with benserazide)

Question 7

what is a COMT inhibitor and how does it work? give an example

Answer 7

stops the Catechol-o-methyltransferase enzyme which metabolises levodopa in body and brain. When taken with levopdopa and a peripheral decarboxylase inhibitor it slows the breakdown. Is used to extend duration levopdopa is effective.
eg. entacapone

Question 8

Name and describe the 3 side effects if someone takes too much dopamine

Answer 8

Dystonia: excessive muscle contraction leads to abnormal postures or exaggerated movements.
Chorea: abnormal involuntary movements that can be jerking and random.
Athetosis: involuntary twisting or writhing movements usually in the fingers, hands or feet.

Question 9

parkinsons tremor or benign essential tremor: affects both hands equally and worse when patient picks up their tea?

Answer 9

BET

Question 10

parkinsons tremor or benign essential tremor: worse when tired/stressed?

Answer 10

BET

Question 11

parkinsons tremor or benign essential tremor: better when drinking alcohol?

Answer 11

BET

Question 12

parkinsons tremor or benign essential tremor: worse when sitting in a chair relaxing?

Answer 12

Parkinsons

Question 13

Hz in parkinsons tremor vs benign essential tremor?

Answer 13

parkinsons - 4-6
BET - 5-8

Question 14

what is parkinsons?

Answer 14

progressive reduction of dopamine (neurotransmitter) by the substantia nigra in the basal ganglia which leads to disorder of movement

Question 15

other symptoms of parkinsons?

Answer 15

depression
sleep disturbance/insomnia
loss of sense of smell
postural instability
cognitive impairment/memory problems

Question 16

parkinsons tremor or benign essential tremor: a tremor and smaller handwriting?

Answer 16

other parkinsonian symptoms so parkinsons

Question 17

what is multiple system atrophy?

Answer 17

• rare condition where the neurones of multiple systems in the brain degenerate
• degeneration of the basal ganglia lead to a Parkinson’s presentation
• degeneration in other areas lead to autonomic dysfunction (postural hypotension, constipation, abnormal sweating and sexual dysfunction) and cerebellar dysfunction (causing ataxia)

Question 18

a patient has rigidity, resting tremor and progressive cognitive decline. what condition is causing this? what about if physical symptoms precede cognitive decline by more than a year?

Answer 18

Dementia with Lewy Bodies (type of dementia associated with features of Parkinsonism). Spherical Lewy body proteins (alpha-synuclein) are deposited in the brain.
if physical symptoms precede cognitive decline by more than a year then considered parkinsons with superimposed cognitive decline

Question 19

associated symptoms of dementia with lewy bodies?

Answer 19

visual hallucinations, delusions, disorders of REM sleep and fluctuating consciousness

Question 20

characteristic histological signs of alzheimer’s dementia? how does this affect the brain?

Answer 20

amyloid plaques and neurofibrillary tangles (made from tau protein).
accumulation of these leads to a reduction in information transmission, and eventually to the death of brain cells

Question 21

patient presents with period of stability at one level of functioning, before an acute decline progression, followed by another period of stability. what do they have?

Answer 21

Vascular dementia - progresses in a stepwise fashion

Question 22

RF for vascular dementia?

Answer 22

previous stroke
hypertension
smoking
diabetes
hyperlipidaemia
obesity
hypercholesterolaemia

Question 23

differential diagnoses of dementia?

Answer 23

severe depression
normal pressure hydrocephalus
HIV-related
brain bleed?

Question 24

name a pathological finding that you may see in a younger patient (<65) with progressive signs of social behaviour, personality and language disturbances

Answer 24

Pick bodies, which contain tau protein inclusions
(fronto-temporal dementia)