Organic/liaison/perinatal (MRCP) Flashcards
A tumour in which of the following areas is most likely to lead to behavioural/psychiatric manifestation? A. Frontal lobe B. Temporal lobe C. Posterior fossa D. Parietal lobe E. Occipital lobe
A. Frontal lobe tumours have been reported to be associated with psychiatric and
behavioural symptoms in as much as 90% of cases. Frontal lobe tumours are associated with
symptoms suggestive of mood disturbances and psychoses, including mania and hypomania,
depression, catatonia, delusions, and hallucinations. Temporal lobe tumours cause psychiatric and
behavioural symptoms in as much as 50–55% of the cases. Pituitary tumours cause psychiatric
manifestations in as many as 60% of cases; parietal lobe – 15%; occipital lobe – 25%; and
diencephalic tumours – 50%.
Which of the following is least associated with a frontal lobe tumour? A. Decline in IQ B. Dysexecutive syndrome C. Disinhibition D. Akinetic mutism E. Manic syndrome
A. Frontal lobe tumours do not generally cause a decline in IQ. Tumours of the frontal
lobes tend to produce symptoms that refl ect their anatomical locations. They usually interfere
with frontally mediated executive functions. Tumours involving the anterior cingulate are
associated with akinetic mutism. Tumours involving the dorsolateral prefrontal convexities are
typically associated with apathy, abulia, lack of spontaneity, psychomotor retardation, reduced
ability to plan ahead, motor impersistence, and impaired attention and concentration. Patients
with orbitofrontal tumours often exhibit personality changes, irritability and mood lability,
behavioural disinhibition and impulsivity, lack of insight, and poor judgement. Tumours of the
ventral right frontal lobe are often associated with euphoria. Tumours of the left frontal lobe
often cause decreased speech fl uency and diminished verbal output, word-fi nding problems, and
circumlocutory speech, whereas tumours affecting both frontal lobes are often associated with
confabulation, Capgras’ syndrome, or reduplicative paramnesias, or a combination of these.
Factors affecting the presence of neuropsychiatric symptoms in head tumours include A. Site of lesion B. Increased intracranial pressure C. Rapidity of growth D. Histopathology of the tumour E. All of the above
E. The anatomical location of a tumour is an important factor that predicts the development
of neuropsychiatric problems in the population. For example, left temporal lobe tumours
are most commonly associated with psychosis. To some extent, the symptoms represent the
underlying function of the involved lobe. The aggressiveness of the tumour itself and the rapidity
and extent of its spread are also believed to be important factors in the type, acuity, and
severity of psychiatric and behavioural symptoms that may be associated with it. Thus, rapidly
growing tumours are frequently associated with more acute psychiatric symptomatology, as well
as signifi cant neurocognitive impairment. In this case, raised intracranial tension is associated
with rapid growth and hence more behavioural problems. In general, the specifi c histological
characteristics of brain tumours have not been shown to be correlated with specifi c psychiatric
and behavioural symptoms. However, as noted previously, more aggressive tumours, such as highgrade
gliomas, are more likely to be associated with acute psychiatric and behavioural symptoms
than are slower growing malignant and benign tumours.
Which of the following has been found to be effective in the treatment of
pathological laughing and crying (PLAC) syndrome?
A. Valproate
B. Moclobemide
C. Citalopram
D. Lithium
E. Thyroxine
C. Pathological emotions are characterized by episodes of laughing or crying, or both, that
are not appropriate to the context. They may be spontaneous or triggered by non-emotional
events. Pathological emotions have classically been explained as secondary to the bilateral
interruption of descending neocortical upper motor neuron innervations of bulbar motor
nuclei. Some patients with pathological emotions have bilateral lesions and pseudobulbar palsy,
but others do not. Most recently, the frontopontocerebellar pathways have been implicated
in the pathogenesis of pathological emotions. It is seen in about 15% of patients with stroke.
Citalopram, as well as nortriptyline, have been found to be effective in the treatment of
pathological crying after stroke in randomized placebo-controlled trials. In addition, post-stroke
depression and PLAC appear to be independent phenomena, although they may coexist.
The lifetime prevalence of psychosis in patients suffering from epilepsy is around A. 1–2% B. 7–12% C. 16–22% D. 27–32% E. 37–42%
B. Psychosis is the specifi c psychiatric disorder most clearly associated with epilepsy. The
lifelong prevalence of all psychotic disorders among epileptic patients ranges from 7% to 12%.
Patients whose epilepsy has a mediobasal temporal focus are especially at risk. Studies on the
laterality of the seizure focus suggest an association of a left-sided focus with psychosis. Although
conclusions derived from surface EEG recording are open to criticism, depth recordings of
presurgical patients show that twice as many patients with left temporal lesions have psychosis.
Which of the following is the most important factor in increasing the risk of
suicide in epilepsy?
A. Presence of comorbid psychiatric disorder
B. Young male
C. Temporal lobe seizure
D. Greater duration of seizure disorder
E. Inadequate therapy
A. Suicide is increased fi vefold among patients with epilepsy. Among patients presenting with
self-harm, epileptic subjects are over-represented from fi ve- to sevenfold. Risk factors for suicide
in epilepsy are ranked as follows: (1) Comorbid psychiatric disorders (2) relatively young males
(ages 25–49 years); (3) temporal lobe seizures (with brain lesions); (4) prolonged duration of the
seizure disorder (5) inadequate therapy (6) personal, social, or occupational diffi culties; and
(7) availability of large amounts of antiepileptic drugs.
Andrew is a 30-year-old man who presented with frontal headaches and
a history of complex partial seizures. Typically, his seizures begin with
20 seconds of orobuccal movements followed by 40 seconds of altered
consciousness. At seizure onset, Andrew feels he must constantly think of
the word ‘Supercalifragilisticexpialidocious’ and repeat this several times
without him being able to control it. What is this phenomenon called?
A. Forced thinking
B. Obsession
C. Compulsion
D. Forced normalization
E. Periodic lateralization
A. This type of psychic aura is called ‘forced thinking,’ characterized by recurrent intrusive
thoughts, ideas, or crowding of thoughts. Forced thinking must be distinguished from obsessional
thoughts and compulsive urges. Epileptic patients with forced thinking experience their thoughts
as stereotypical, out-of-context, brief, and irrational, but not necessarily as ego dystonic. Periodic
lateralizations are recurrent EEG complexes that may be associated with prolonged confusional
behaviour and focal cognitive changes.
The phenomenon where the onset of peri-ictal psychosis occurs as a result
of control of epileptic seizures is called
A. Forced normalization
B. Forced thinking
C. Periodic lateralization
D. Twilight state
E. Geschwind syndrome
A. Periictal psychotic symptoms more often worsen with increasing seizure activity. Rarely,
psychotic symptoms alternate with seizure activity. In this ‘alternating psychosis’, as long as the
patient’s seizures are not controlled, they are free of psychotic symptoms, but when they are
seizure free and their EEG has ‘forced’ or ‘paradoxical normalization’, they manifest psychotic
symptoms. This alternating pattern is much less common than the increased emergence of
psychotic behaviour with increasing seizure activity. Twilight states are episodes of confusion that
may be associated with the seizure (ictal) or after a seizure (post ictal). They may be associated
with odd behaviours, and the patient is usually not conscious about the behaviour. Geschwind
syndrome is otherwise called epileptic personality. It consists of a cluster of personality traits
including hyposexuality, hypergraphia, hyperviscosity, hyperreligiosity seen in patients with
long-standing epilepsy.
Which of the following is NOT considered a feature of irritable bowel
syndrome (IBS)?
A. Abdominal discomfort not relieved by defaecation
B. Altered stool frequency
C. Altered stool form
D. Altered stool passage
E. Passage of mucus
A. IBS is the prototypical functional gastrointestinal disorder characterized by abdominal pain
and diarrhoea or constipation. The International Congress of Gastroenterology has developed a
standardized set of criteria for IBS. They include either abdominal pain relieved by defaecation or
associated with a change in frequency or consistency of stool; or disturbed defaecation involving
two or more of the following: altered stool frequency; altered stool form hard or loose and
watery; altered stool passage straining or urgency or feeling of incomplete evacuation; passage of
mucus. IBS can be categorized into diarrhoea-predominant, constipation-predominant, and mixed
subtypes. Medical treatment often targets the predominant symptom. IBS accounts for as much as
50% of all outpatient evaluations done by gastroenterologists.
Which of the following is NOT a model that has been proposed to explain
the relationship between IBS and high rates of psychiatric comorbidity?
A. Somatization disorder hypothesis
B. Somatopsychic hypothesis
C. Psychogenic hypothesis
D. Self-selection hypothesis
E. Conversion hypothesis
E. Studies of psychiatric comorbidity in IBS estimate rates of comorbidity at 42–64% of all
IBS patients. The exact mechanism for high rates of psychiatric comorbidity in IBS is unknown.
Four models have been proposed to explain the relationship between IBS and high rates of
psychiatric comorbidity. The fi rst model is the somatization disorder hypothesis. This model
classifi es IBS as one of a group of diagnoses that can be made from a primary somatization
disorder or other somatoform disorder. The somatopsychic hypothesis states that psychological
symptoms are the result of chronic gastrointestinal distress and the unsatisfactory interaction
with healthcare providers who do not accurately diagnose and treat IBS. Psychogenic hypothesis
states that specifi c psychiatric disorders cause IBS for a signifi cant proportion of patients.
Panic disorder, in particular, is proposed as a cause for secondary IBS. The self-selection model
proposes that psychiatric comorbidity increases the rate of treatment seeking in patients who
have IBS.
Which of the following is a psychosocial risk factor for the development of peptic ulcer? A. History of major depressive disorder B. History of an anxiety disorder C. History of sexual abuse D. History of childhood neglect E. All of the above
E. Since the discovery of Helicobacter pylori, interest in the association of peptic ulcer and
psychosocial factors has diminished. Nevertheless, psychosocial factors do play a role in the
development of ulcers in susceptible individuals. Data from the National Comorbidity Survey
have shown that generalized anxiety disorder (GAD) is associated with an increased risk of
self-reported peptic ulcer disease. Longitudinal prospective studies have shown that depression
and anxiety at baseline increase the risk of ulcer development. Childhood physical abuse, sexual
abuse, and neglect are also associated with a statistically increased risk of peptic ulceration in
addition to other physical conditions. Acute severe stress in human beings, provoked by wars
or earthquakes, can precipitate ulceration in susceptible individuals. Once formed, psychosocial
factors can delay recovery and contribute to a worse prognosis.
Which of the following is NOT a risk factor for the development of peptic ulcer? A. Cigarette smoking B. Heavy alcohol consumption C. Lack of sleep D. Not eating breakfast E. High socioeconomic status
E. Lifestyle factors predict the development of peptic ulcer in susceptible individuals.
They are potential mediators in the aetiological matrix between stress and ulcer. These include
cigarette smoking; heavy alcohol consumption; lack of sleep; not eating breakfast; non-steroidal
anti-infl ammatory drugs; hard on-the-job labour and low socioeconomic status
Which of the following is an early symptom/sign of HIV dementia? A. Forgetfulness B. Confusion C. Disorientation D. Slowing of verbal responses E. Carphologia
A. Organic and neuropsychiatric disorders in HIV are common, and may result from the
direct effects of HIV, opportunistic infections, effects of neoplasms, metabolic abnormalities,
iatrogenic interventions and others. The prevalence of HIV dementia is around 10–15%. Cognitive
changes may be directly due to the effects of HIV itself, secondary to opportunistic infection
following treatment, or due to pre-existing psychological morbidity. These changes may be
classifi ed into early and late. Early symptoms consist of forgetfulness, poor concentration, balance
problems, apathy, withdrawal, dysphoric mood, and dyspraxia. Symptoms that are suggestive of a
late change include disorientation, confusion, peripheral neuropathies, slowed verbal responses,
indifference to illness, organic psychosis, incontinence, and carphologia (picking imaginary objects
and bed linen).
According to the WHO classifi cation, the normal range of body mass index (BMI) is A. 16–18.50 B. 18.50–24.99 C. 25–29.99 D. 30–34.99 E. None of the above
B. BMI is a simple index of weight-for-height that is commonly used to classify underweight,
overweight, and obesity in adults. It is defi ned as the weight in kilograms divided by the square
of the height in metres (kg/m2). BMI values are age independent and the same for both sexes.
However, BMI may not correspond to the same degree of fatness in different populations
due, in part, to different body proportions. The health risks associated with increasing BMI are
continuous and the interpretation of BMI grading in relation to risk may differ for different
populations: underweight <18.50; normal range 18.50–24.99; overweight ≥25.00; pre-obese
25.00–29.99; obese ≥30.00; obese class I 30.00–34.99; obese class II 35.00–39.99; obese class III
≥40.00.
Which of the following is considered the cardinal feature of delirium? A. Disturbance of sleep wake cycle B. Psychomotor disturbance C. Hallucinations D. Disturbance of consciousness E. Affective lability
D. The clinical presentation of delirium is defi ned by psychopathology and temporal course.
It is usually of acute onset and the cardinal feature is a disturbance in consciousness. Impairment
of consciousness is the key feature that separates delirium from most other psychiatric disorders.
There is a continuum between mild impairment of consciousness and near unconsciousness.
There is fl uctuation in intensity, and symptoms are often worse at night. The other features
are an inability to focus and maintain attention, perceptual disturbances, disorientation in time
and/or space, rarely to people (though false recognition is common) and almost never to self.
Disorientation to time is often the first warning sign of delirium. Attention is poor and the patient
is easily distractable, looking either apathetic or intensely focused upon something. Psychomotor
disturbance may be in the form of agitation or retardation. Other features may include lability of
mood and incoherent speech.
Which of the following is a feature of systemic lupus erythematosus (SLE)?
A. Late involvement of the central nervous system (CNS)
B. CNS events strongly correlate with systemic disease activity
C. Neuropsychiatric manifestations correlate with the presence of anticardiolipin antibodies
D. 90% of the people diagnosed with SLE suffer from depression
E. Stress has not been linked with exacerbation in SLE
C. Psychiatric manifestations are common in SLE. Up to 90% of patients have some
neuropsychiatric manifestation. In most patients, CNS complications present early in the illness,
and studies that have looked into it have found no relationship between systemic disease activity
and neuropsychiatric manifestations. In fact, neuropsychiatric causes are second only to renal
causes as far as mortality is concerned in these patients. These complications include stroke,
seizures, transverse myelitis, etc. Cognitive defi cits are the most common neuropsychiatric
manifestation in these patients. It is present in up to 80% of the patient sample. These have been
correlated with the presence of anticardiolipin antibody. In this way, most psychiatric illnesses
have been correlated with the presence of an antibody in the blood. Depression has been
reported in up to 40% of people with SLE. Psychiatric symptoms in SLE have been attributed to
direct CNS involvement, infections, side-effects of medications, reactions to chronic illness and
primary psychiatric illness. Similarly, stress has been linked to exacerbation of SLE. This is said to
be mediated through the immune system.
Which of the following is a characteristic feature of paediatric autoimmune neuropsychiatric disorder due to group A streptococcal infection (PANDAS)? A. Arthritis B. Carditis C. Rheumatic fever D. Chorea E. Tics
E. PANDAS is a controversial disease. In fact, Levinson says that it is not a diagnosis, but
a syndrome where obsessive compulsive disorder and tics have been exacerbated in children
following a group A beta-haemolytic streptococcal (GABHS) infection. The diagnostic criteria
for PANDAS that were proposed by Swedo et al. in 1998 include the following: OCD and/or
chronic tic disorder (Tourette’s, chronic motor, or vocal tic disorder) that meets the DSM-IV
diagnostic criteria; age at onset between 3 years and the onset of puberty; clinical course with an
abrupt onset of symptoms and/or a pattern of dramatic recurrent exacerbations and remissions;
temporal relation between GABHS infection and onset and/or exacerbations of clinical
symptoms; and neurologic abnormalities such as motoric hyperactivity, tics, or choreiform activity
during an exacerbation.
Which of the following is the most common psychiatric manifestation of hyperthyroidism? A. Major depression B. Anxiety disorder C. Cognitive disorder D. Psychosis E. None of the above
A. Despite the fact that anxiety is a cardinal feature of hyperthyroidism, anxiety disorders
are observed in only up to 15% of the patients. Major depression is the most common
psychiatric manifestation, seen in up to 25% of the people diagnosed with hyperthyroidism.
Cognitive disturbance is seen in around 7.5% of patients. Mania and hypomania are less common,
with a prevalence of around 2%, and psychosis occurs in around 2% of the population with
hyperthyroidism.
Which of the following is the most commonly reported psychiatric symptom in hypothyroidism? A. Depression B. Cognitive disturbance C. Anxiety D. Psychosis E. None of the above
B. Patients with hypothyroidism present with all of the above symptoms. But the most
commonly reported psychiatric symptoms are that of cognition, which occurs in around 45% of
the patients. This can extend from mild subjective slowing to delirious and even encephalopathic
states. Delirium is the most severe manifestation of hypothyroidism. Depression is the second
most frequent psychiatric syndrome. Anxiety disorder is present in around 30% of the patients,
and although myxoedema madness ‘psychosis’ is one of the most common symptoms reported in
the literature, it represents only around 5% of psychiatric morbidity in these patients
Regarding corticosteroid-induced neuropsychiatric complications, which of
the following statements is true?
A. Predominantly affective illness
B. Severity of symptoms is dose related
C. Complications tend to occur in the fi rst 2 weeks of starting therapy
D. Lithium prophylaxis is helpful
E. All of the above
E. Nearly all steroids have been implicated. Psychiatric symptoms are mostly affective in
nature, more specifi cally elation. Psychosis, delirium, and anxiety have been reported. Steroidinduced
psychosis may be secondary to delirium, an exacerbation of pre-existing psychosis
or frank psychosis precipitated by steroids (this includes mania). The prevalence of psychiatric
disturbance in patients who have been administered corticosteroids is said to be dose related.
Various strategies to prevent the onset of steroid-induced psychiatric manifestations include
administering the medication in divided doses, enteric coated preparations, lithium, and valproate
prophylaxis for those with a previous history. Tricyclic antidepressants (TCAs) are best avoided as
these have been associated with an exacerbation of symptoms
Which of the following is the most common psychiatric manifestation of Cushing’s syndrome? A. Major depression B. Mania C. Anxiety disorder D. Psychosis E. Cognitive disorders
A. Full depressive syndrome has been reported in up to 70% of people with Cushing’s
syndrome. The most common cause of Cushing’s syndrome is pharmacological. Cushing’s
disease is a primary pituitary tumour, which secretes an excess of adrenocorticotropic hormone
(ACTH). Psychiatric manifestations may be due to the direct effects of elevated corticosteroids
on the neurons or due to hypothalamic dysfunction. The neocortex and hippocampus have
glucocorticoid receptors, the action on which could explain the cognitive and mood disorder
seen in these patients. Cushing’s disease has been associated with a reduction in hippocampal
volume, which is reversed on correction of steroid levels. There is also some evidence to show
that stress could be associated with exacerbation of the illness
A 60-year-old woman who recently underwent radiation therapy to her
neck presented with ‘painful bones, renal stones, abdominal groans, and
psychic moans’. Which of the following condition is she most likely to be
suffering from?
A. Hyperparathyroidism
B. Hypoparathyroidism
C. Hyperthyroidism
D. Hypothyroidism
E. None of the above
A. This patient shows the classical features of hyperparathyroidism leading to
hypercalcaemia, possibly precipitated by the irradiation to the neck. The psychic moans are most
commonly due to depression and cognitive symptoms. These have been correlated with the
degree of calcium elevation. In severe cases, confusion, catatonia, agitation, psychosis, and coma
can occur. Most patients improve with treatment and correction of calcium levels
The prevalence of major depressive disorder in patients with Huntington’s disease is around A. 1% B. 5% C. 15% D. 40% E. 80%
D. Huntington’s disease is an autosomal dominant disorder resulting from a mutation on
chromosome 4, which leads to an increased number of CAG trinucleotide repeats from 6–34 to
39–86. Patients with longer trinucleotide repeat lengths have an earlier age of onset and more
rapid progression than those with fewer repeats. It is seen that those who inherit the disease
from the paternal side have a greater number of repeats and hence show an earlier age of onset,
a phenomenon called genetic anticipation. Clinically, Huntington’s disease is manifested by the
triad of chorea, dementia, and psychiatric symptoms. Approximately 40% of patients exhibit
major depressive disorders or meet criteria for dysthymia. Approximately 10% of patients exhibit
hypomania and a few may have manic episodes. Apathy, irritability, and disinhibition may be
present independent of a mood disorder. Sexual misconduct is more common, occurring in up to
20% of Huntington’s disease patients. The rate of suicide is increased up to four times in patients
with Huntington’s disease. Psychiatric symptoms do not correlate with the CAG repeat length.
Which of the following is a feature of cognitive dysfunction in Huntington’s
disease?
A. Sparing of verbal recall
B. Late-onset verbal memory and visuospatial dysfunction
C. Sparing of procedural memory
D. Early executive function loss
E. Loss of speech comprehension before the loss of speech production
D. Verbal recognition is relatively spared compared with recall, which suggests a retrieval
problem rather than an encoding problem. Problems with verbal memory and visuospatial
function appear early in Huntington’s disease, but don’t progress as much as in patients with
Alzheimer’s. The picture is typical of a subcortical dementia involving frontal subcortical circuits.
Patients with Huntington’s disease show a typical loss of procedural memory. Executive function
is lost early in the disease. They also show psychomotor slowing and attentional defi cits that
correlate with activities of daily living (ADL). Unlike psychiatric symptoms, cognitive symptoms
correlate with the number of trinucleotide repeats. Speech comprehension is maintained late
into the disease well after intelligible speech production is lost
Which of the following is a feature of amnestic mild cognitive impairment
(MCI)?
A. Absence of subjective memory complaints
B. Absence of memory impairment relative to age-matched healthy control
C. Presence of evidence of clinical dementia
D. Presence of diffi culties in ADL
E. Amyloid deposits and tau-positive tangles are seen more often in the mesial temporal
lobes than in normal controls
E. MCI is a syndrome characterized by the presence of cognitive decline greater than that
expected for age and education level along with normal ADL. It is, thus, distinct from dementia,
in which cognitive defi cits are more severe and widespread and have a signifi cant effect on
daily function. A further subtype of MCI, amnestic subtype, has a higher rate of conversion to
Alzheimer’s disease. They characterized by memory complaints, corroborated by an informant:
the presence of memory impairment relative to age- and education-matched healthy people;
typical general cognitive function; largely intact ADL; and not clinically demented. Prevalence in
population-based epidemiological studies ranges from 3% to 19% in adults older than
65 years. Compared with people with dementia and normal controls, individuals with MCI
have intermediate amounts of Alzheimer’s disease pathology, including amyloid deposition and
tau-positive tangles in the mesial temporal lobes
Which of the following is a monogenic ischaemic stroke syndrome?
A. CADASIL
B. Moya Moya disease
C. Reversible posterior leucoencephalopathy
D. Binswanger’s disease
E. Necrotizing arteritis
A. CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and
leucoencephalopathy) is an autosomal dominant familial trait linked in several families to a
mutation in the Notch 3 gene on chromosome 19. It presents as recurrent small-vessel strokes,
beginning in early adulthood, leading to extensive symmetric white matter changes similar to
Binswanger’s disease and progressive dementia. The genetic nature of the syndrome may not be
fully apparent because of the low penetrance. Approximately 40% of patients have migraine with
aura. CADASIL is the only monogenic ischaemic stroke syndrome described. Genetic testing is
available.
Which of the following is NOT a feature of Stage I Alzheimer’s dementia? A. Memory impairment B. Visuospatial impairment C. Anomia D. Impairment in calculation E. Background slowing on EEG
E. According to Cummings, Alzheimer’s disease progresses through three stages. In the
fi rst stage, the patient has anomia, defective visuospatial skills and calculation ability along with
an indifferent personality. Examination of the motor system and EEG may be relatively normal,
although some medial temporal atrophy may be noted in a structural brain scan. In the second
stage of dementia, the patient has fl uent aphasia and further deterioration in memory, visuospatial
skills, and personality. In addition, there may be motor restlessness on examination. EEG may
show background slowing and a structural brain scan may show temperoparietal atrophy. In the
third and fi nal stage, there is severe impairment in intellectual function and speech disturbances
characterized by palilalia, echolalia, or mutism. In addition, there is sphincter disturbances, diffuse
slowing on EEG and diffuse atrophy on structural scan.
Which of the following is NOT a feature of Binswanger’s disease?
A. Rapidly progressive dementia
B. Clinical signs may include parkinsonian syndrome
C. Fluctuating mental state is seen
D. Deep white mater demyelination in periventricular areas
E. Typically seen in chronic hypertensive patients
A. Binswanger’s disease is a slowly progressive dementia associated with subacute
progression of focal neurological defi cits in chronically hypertensive patients. These defi cits could
involve pseudobulbar, pyramidal, and parkinsonian features. Incontinence and fl uctuating cognition
may be seen. The periventricular area shows white matter demyelination, especially resulting
from diffuse ischaemic damage. Lacunar infarcts are frequently absent. In patients thought to have
multi-infarct dementia, leucoaraiosis is found in at least three quarters.
Which of the following is true regarding frontotemporal dementia (FTD)?
A. Semantic dementia is the most common subtype
B. The frontal variant is characterized by loss of word meaning and object recognition
C. 40% of cases of FTD are familial autosomal dominant
D. Pick bodies are immunoreactive to ubiquitin, but not to tau
E. Pick’s disease is the most common histological variant
C. Forty per cent of cases of FTD are familial, mainly autosomal dominant. Mutations in
the tau gene were fi rst found in FTD with parkinsonism linked to chromosome 17 (FTDP-17).
Histologically FTD consist of fi ve types. The motor neuron type with inclusions reactive for
ubiquitin but not for tau is the most frequent type. The second most common is a corticobasal
degeneration type that is tau positive but with ubiquitin-negative inclusions. The third is Pick’s
disease with neuronal loss, widespread gliosis, and infl ated neurons with inclusions positive for
both tau and ubiquitin. The familial pattern has tau-positive inclusions in neurons and glial cells.
Clinically frontal lobe variant accounts for the most common presentation (70%). They present
with symptoms suggestive of frontal lobe dysfunction. Temporal variants are of two types:
semantic and progressive aphasic. Semantic dementia accounts for about 15% of the presentation.
They show progressive loss of word meaning and object or face identity. Ten per cent of cases are
of the progressive aphasic type.
