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Neurology > Neurodegenerative ETC > Flashcards

Neurodegenerative ETC Flashcards

1
Q

Memory loss over months or years

A

Dementia

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2
Q

Memory loss over weeks

A

Depression

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3
Q

Memory loss over days

A

Infection or stroke

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4
Q

Prevalence of Dementia

A

Rare if 65 years
20% if >80 years
79% if >100 years

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5
Q

Associated symptoms of dementia

A

Agitation, aggression, wandering, hallucinations, slow repetitious speech, apathy

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6
Q

Ameliorable metabolic causes of dementia

A

Hypothyroidism
B12/folate deficiency
Pellegra (tryptophan/nicotinic acid - vit B3 deficit)

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7
Q

Infective causes of dementia

A

Neurocystericosis
HIV
Syphilis
Whipple’s disease

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8
Q

CNS causes of dementia

A

PD
Alzheimer’s Disease
Subdural haematoma
Tumours - meningioma

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9
Q

What % of dementia is vascular dementia

A

25%

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10
Q

What causes vascular dementia

A

Cumulative effects of many mini-strokes

Sudden onset and stepwise progression are features

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11
Q

3rd most common cause of dementia?

A

Lewy Body Dementia
Fluctuating cognitive impairment
with visual hallucinations
Followed by parkinsonism

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12
Q

Signs of fronto-temporal dementia

A

Executive impairment
Behavioural/personality changes early on
Early preservation of episodic memory
Disinhibition and emotional unconcern

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13
Q

Medication for disinhibition/altered behaviour in dementia

A

Trazodone (antipsychotic) or lorazepam

If worse - quetiapine, risperidone, olanzapine - but will worsen cognition

Haloperidol used short-term

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14
Q

Medication for depression in dementia

A

SSRI eg. citalopram

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15
Q

Drugs to avoid in dementia

A

Neuroleptics/antipsychotics, sedatives, tricyclics

These all impair cognition

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16
Q

Main features of AD

A 
Progressive global cognitive impairment
Visuo-spatial skill decrease
Memory loss
Decreased verbal abilities
Executive function (planning)
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17
Q

What is anosognosia?

A

Lack of insight into the problems engendered by the disease

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18
Q

Pathology of AD

A

B-amyloid accumulation in amyloid plaques
Neurofibrillary tangles
Decreased acetylcholine

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19
Q

Risk factors for AD

A

1st degree relative with AD
Down’s syndrome (AD inevitable)
ApoE E4 allele homozygote
Vascular risk factors - vascular dementia in 95% of AD patients

Low physical or cognitive activity
Depression
Loneliness
Smoking >20 cigarettes a day accelerates onset by 2.3years

20
Q

Prognosis of AD

A

Mean survival is 7 years from onset of unequivocal symptoms

21
Q

Medication in AD

A

Acetylcholinesterase inhibitors
Appear to help more with laying down of new memories than the conservation of old memories
Seem to help in dementia of PD and LB dementia

Eg. Donepezil, Rivastigmine, Galantamine

22
Q

Side effects of acetylcholinesterase inhibitors

A

Worsen peptic ulcer disease and heart block
D&V, cramps
Incontinence
Headaches , dizziness, insomnia

23
Q

Another non-Ach medication in AD

A

Memantine
NMDA antagonist
Reasonably effective in late stage disease

24
Q

3 primary features of Parkinsonism

A

Tremor - resting tremor, pill-rolling
Rigidity - Cogwheel rigidity
Bradykinesia - slow to initiate movement and slow movement

Therefore festinating gait (decreased arm swing)
Micrographia
Expressionless face
Monotonous hypophonic speech

25
Q

Typical age of onset of PD

A

65 years

26
Q

Pathology of PD

A

Mitochondrial DNA dysfunction leads to degeneration of dopaminergic neurons in the SN of the BG

27
Q

Features of bradykinesia in PD

A

Progressive fatiguing - decrement in amplitude of repetitive movement

Upper limb usually affected first and is unilateral

28
Q

Features of tremor in PD

A

Unilateral in upper limb then to lower limb on that side and then to other arm

Made worse by emotion or stress

Unmasking - overflow - count backwards from 10

29
Q

Features of rigidity of PD

A

Unmasked - synkinesis - get to move other arm

Also called reinforcement

30
Q

Features of posture and gait in PD

A

Postural instability and hypotension - not usually present in first 5 years of disease

31
Q

Feature which may lead to death in PD

A

Speech and swallowing difficulties - therefore aspiration pneumonia as terminal event

32
Q

Sleep in PD

A

REM Behaviour Disorder
Talking and thrashing out in sleep with no recollection

Treat with clozapine or quetiapine

33
Q

Main medication in PD

A

L-DOPA

Given with domperidone to prevent nausea and vomiting

Also Carbidopa or Benserazide to prevent peripheral conversion

34
Q

Levodopa extender

A

Entacapone

COMT inhibitor

35
Q

DA agonists

A

Ropinirole and pramipexole

Rotigotine patches

Bromocriptine/pergolide and cabergoline - not really used because can cause heart problems and lung fibrosis

36
Q

Preventing breakdown of dopamine at synapse

A

Selegeline and rasagiline

MAOinhibitors

37
Q

Management of LDOPA induced dyskinesia

A

Amantadine

Anticholinergics - Benzhexol and Orphenadrine

38
Q

Treatment of ON-OFF

A

Apomorphine - short-acting DA agonist

L-Dopa intestinal gel infusion pump

Avoid protein rich meals - prevents levodopa absorption

39
Q

Features of Progressive Supranuclear Palsy

A

Postural instability early on
Pseudobulbar palsy
Vertical supranuclear gaze palsy (can’t look up or down)

Also dementia and parkinsonism

Little response to L-DOPA (but parkinsonian features may respond)

40
Q

Features of Multi-System Atrophy

A

Parkinsonism is more symmetrical and WITHOUT TREMOR

Autonomic failure - severe

Olivopontocerebellar atrophy - cerebellar signs

PD features may respond but Ldopa

41
Q

Cortico basal degeneration features

A

Alien limb phenomenon

Myoclonus

PD signs and dementia

LDOPA has no effect

42
Q

What type of tremor caused by cerebellar problems?

A

Intention tremor

43
Q

What is a essential tremor, two types and what causes it?

A

Postural - when limb held out against gravity
Kinetic - present on movement

eg. 
Benign essential tremor 
Thyrotoxicosis 
Anxiety 
B-agonists

Essential - improves with alcohol

44
Q

Causes of chorea

and treatment

A 
Huntingtons 
Sydenhams chorea (strep)

Thyrotoxicosis
SLE

Dopamine blocking drugs or treat underlying disorder

45
Q

Egs of Tics

and treatment

A

Tourettes (motor and vocal)
Physical tics
Clonazepam and clonidine if severe

46
Q

Dystonia examples

A

Primary dystonia - children/young adult, usually starts with foot and then spreads - treat with DBS

Focal dystonias - torticollis - writers cramp, blepharospasm - worsened by stress - treat with BOTOX

Neurology (10 decks)

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