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Psychiatry > Neurobiology of cognition and dementia > Flashcards

Neurobiology of cognition and dementia Flashcards

1
Q

What is Broca’s aphasia also known as

A

expressive aphasia

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2
Q

Broca’s aphasia has good/poor comprehension and good/poor speech

A

good comprehension

poor speech

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3
Q

What is Wernicke’s aphasia also known as

A

receptive aphasia

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4
Q

Wernicke’s aphasia has good/poor comprehension and good/poor speech

A

poor comprehension

good speech

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5
Q

define dementia

A

progressive, irreversible, global cognitive decline

disruption to higher cortical function in clear consciousness

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6
Q

can you get dementia after a large stroke

A

no, because onset of dementia is progressive/chronic

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7
Q

which Brodmann area is the primary motor cortex

A

4

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8
Q

which brain structure is important for incorporating short into long term memory

A

hippocampus

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9
Q

what is damaged in Alzheimer’s disease

A

nucleus basalis of Meynert in medial temporal lobe

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10
Q

which pathways are disrupted in Alzheimers

A

ACh

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11
Q

molecular features of Alzheimers

A

extracellular amyloid plaques

intracellular neurofibrillary tangles (tau)

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12
Q

symptoms of Alzheimers

A 
short term memory loss 
dysphasia
dyspraxia 
agnosia 
poor adaptability 
psychosis 
dysphagia - late stage
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13
Q

management of Alzheimer’s disease

A

acetylcholinesterase inhbitors eg

donepezil, rivastigmine, galantamine

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14
Q

what is memantine

A

low affinity, voltage dependent, non-competitive NMDA antagonists

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15
Q

what is vascular dementia

A

stepwise progression after accumulative small infarcts

overlaps with Alzheimers

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16
Q

features of vascular dementia

A

affects white matter
dysphasia, dyscalculia
mood symptoms
focal neurological signs

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17
Q

what is the damage in Lewy Body Dementia DLB

A

a-synuclein and ubiquitin at higher quantities in the brain
loss of dopaminergic neurons in substantia nigra
presence of lewy bodies
loss of ACh in nucleus basalis of meynert

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18
Q

features of lewy body dementia

A 
fluctuating 
visual hallucinations 
parkinsonism 
autonomic instability 
visuospatial problems 
REM behavioural disorder
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19
Q

which drugs should be avoided in lewy body dementia

A

dopamine agonists eg sinemet

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20
Q

management of lewy body dementia

A

acetylcholinesterase inhibitors

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21
Q

timing of dementia in Parkinson’s disease

A

dementia within 1 year of symptoms = DLB

dementia after 1 year of symptoms = parkinson’s disease dementia

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22
Q

damage in frontotemporal lobe dementia

A

atrophy of frontal and temporal lobes with corresponding reduction in activity
gliosis
abnormal proteins

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23
Q

symptoms of FTD

A

social disinhibition
early onset
personality changes
apathy

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24
Q

what are the types of FTD

A

behavioural
progressive non-fluent
semantic

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25
Q

cause of Wernicke’s encephalopathy

A

thiamine/vit B1 deficiency

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26
Q

wernicke’s encephalopathy triad of symptoms

A

confusion
ataxia
ophthalmoplegia

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27
Q

symptoms of wernicke’s encephalopathy

A 
confusion
ataxia
ophthalmoplegia 
visual and hearing impairments 
reduced consciousness
hypothermia 
lactic acidosis 
circulatory changes
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28
Q

what should be given in wernicke’s encephalopathy to prevent progression to Korsakoff’s

A

IV pabrinex (vitamins)

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29
Q

what is the damage in Korsakoff’s syndrome

A

damage to mamillary bodies

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30
Q

symptoms of Korsakoff’s

A

confabulation
anterograde amnesia
telescoping of events

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31
Q

is alcohol induced brain damage a type of dementia

A

no

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32
Q

consequences of alcohol induced brain damage

A

Wernicke-Korsakoff
myelin sheath degradation
neuroinflammation
falls

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33
Q

differentials of dementia

A 
delirium 
depression --> pseudodementia
deafness
dysphasia 
late onset Schizophrenia 
subdural haematoma 
tumours 
infection
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34
Q

duration of sensory memory

A

<1 sec

35
Q

duration of short term memory

A

<1 min

36
Q

duration of long term memory

A

lifetime

37
Q

explicit memory is conscious/unconscious

A

conscious

38
Q

implicit memory is conscious/unconscious

A

unconscious

39
Q

difference between episodic memory and semantic memory

A 
episodic = personal events and experiences
semantic = facts, concepts, knowledge
40
Q

anterograde amnesia

A

difficulty in acquiring new information since onset of illness

41
Q

retrograde amnesia

A

difficulty in acquiring new information prior to onset of illness

42
Q

defining factors of dementia

A

progressive ie >6 months
global cognitive decline
disturbance of higher cortical functions
clear consciousness

43
Q

what are useful questions to ask in a dementia history

A 
day to day life affected
problems in kitchen 
difficulty with technology 
news/newspaper
driving 
hobbies
44
Q

what does cognitive screening assses

A 
memory 
attention + concentration 
executive functioning
visuo-spatial functioning
language
45
Q

what is the 4AT and what are its elements

A 
rapid assessment for delirium 
Alertness
AMT4
Attention 
Acute
46
Q

which screening test should be used initially in the case of dementia

A

MMSE

47
Q

advantages and disadvantages of MMSE

A

Adv: quick, different languages, pen and paper only
Disadv: poor examination of executive functioning, copyrighted

48
Q

MMSE of what score supports and excludes dementia

A

> 27/30 - excludes

<24/30 - supports

49
Q

when is the 6-CIT used

A

in non-specialist settings

bedside test

50
Q

what is the GPCOG

A

6 questions asked in the GP/community setting

51
Q

scoring of GPCOG

A

9 = normal
5-8
0-4 = poor

52
Q

what is the clock drawing test

A

assesses executive function, visuospatial ability

53
Q

what is the MoCA

A

Montreal Cognitive Assessment
rapid screening instrument for mild cognitive dysfunction
freely available

54
Q

what is ACE

A

addenbrooke’s cognitive assessment

scored out of 100 and assesses 5 domains

55
Q

what is a normal score in ACE

A

> 84/100

56
Q

what is neuropsychological assessment

A

determines abnormal intellectual/behavioural decline and whether it is relating to CNS disease

57
Q

what is CMHT

A

community mental health team

58
Q

what is post diagnostic support for dementia

A

for patient + family/friends after diagnosis including counselling, financial advice/legalities power of attorney …

59
Q

what cognitive testing is available

A

ACEIII
MoCA
frontal assessment battery FAB
detailed neuropsychological testing

60
Q

what is the shortIQCODE used for

A

taking a collateral history

61
Q

who carries out a cognitive performance test

A

OT

62
Q

what are reversible causes of cognitive impairment

A 
VINDICATE
delirium 
alcohol 
drugs 
endocrine 
depression 
brain lesion 
infections
63
Q

define mild cognitive impairment

A

noticeable cognitive impairment with little deterioration in functioning

64
Q

ACEIII and MoCA scores for mild cognitive impairment

A

ACEIII 75-90/100

MoCA 24-26/30

65
Q

what is subjective cognitive impairment

A

patient feels cognitively impaired but the tests are all normal

66
Q

criteria for DLB

A 
visual hallucinations 
fluctuating 
parkinsonism 
REM behavioural disorder 
positive DAT scan
67
Q

can you diagnose dementia from a scan

A

NO

68
Q

role of CT scan

A

excludes lesions, bleeds, stroke, vascular changes, structural changes

69
Q

indication for MRI

A

young
fast progression
atypical features

70
Q

what is a SPECT scan most useful for

A

FTD

sometimes to clarify Alzheimer’s

71
Q

when is a DAT scan used

A

suspected DLB/DPD when there arent enough supporting features

72
Q

what do acetylcholinesterase inhibitors do

A

increase ACh at synaptic cleft

73
Q

pharmacological management of Alzheimer’s

A

donepezil
rivastigmine
glanatamine

74
Q

pharmacological management of DLB/DPD

A

rivastigmine

75
Q

side effects of AChE inhibitors

A 
nausea, diarrhoea
headaches 
muscle cramps 
bradycardia 
worsen asthma/COPD
76
Q

contraindications to AChE inhibitors

A

active PUD

asthma/COPD

77
Q

what is memantine

A

NMDA antagonist to slow cognitive decline in Alzheimer’s

started in moderate dementia

78
Q

what does memantine prevent

A

BPSD

behavioural and psychological symptoms of dementia

79
Q

side effects of memantine

A 
hypertension 
sedation 
dizziness
headache 
constipation
80
Q

somebody with a dementia diagnosis must report to the DVLA, true or false

A

true

81
Q

what form is filled in with regards to driving

A

CG1 form

82
Q

what is the Rockwood Driving Battery Test

A

assesses different aspects of driving

83
Q

what are features of BPSD

A 
hallucinations 
delusions 
insomnia
anxiety 
depression 
aggression 
disinhibition 
agitation

Psychiatry (27 decks)

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