Psych Flashcards
Pick’s disease is also known as
Frontotemporal lobe dementia
What are the signs of pick’s disease
The most common variant is behavioral which is characterized by loss of social inhibition, ritualized behaviors, apathy, aggression, and lack of insight.
What would be the CT findings in picks disease
What about postmortem
CT and MRI of the head will show focal atrophy in the frontal and temporal lobes.
On autopsy, pathologic examination may reveal round intraneuronal inclusion bodies (also called “Pick bodies”), which are diagnostic.
A patient presents with incontinence, ataxia and dementia. What is the likely diagnosis.
What about:
A patient presents with subacute dementia, ataxia and myoclonic jerks?
- Normal pressure hydrocephalus.
Patients are wet, wobbly and wacky (incontinence, ataxia, and dementia)
- Creutzfeldt jakob disease
Extremely rare but progressive prion disease
What are the main symptoms of lewy body dementia (DLB)
Fluctuating levels of
confusion, hallucinations and a resting tremor.
Outline the histology and location of the lewy bodies in lewy body dementia
DLB is characterised by
the accumulation of abnormal aggregates of proteins, called Lewy bodies in the
cytoplasm of neurons.
It also leads to a loss of dopaminergic neurons in the
substantia nigra, resulting in features of parkinsonism (resting tremor, postural
instability, bradykinesia and rigidity).
t/f Lewy body dementia is the most common cause of dementia after alzheimers
T
What are the typical dementia symptoms
anterograde amnesia, confusion,` changes in personality and mood and
difficulty planning.
Rapidly progressive demential with memory loss, myoclonus, cerebella or visual dysfunction
Creutzfeldt–Jakob disease is an infectious prion disease which causes a rapid neurodegenerative process resulting in symptoms such as dementia , myoclonus , cerebella or visual dysfunction.
Presence of which protein in CSF can lead to diagnosis of Creutzfeldt–Jakob disease
Presence of 14-3-3 protein in the
cerebrospinal fluid
can lead to the diagnosis of this disease.
EEG should be done too
Pick’s disease
Pick's disease is one of the frontotemporal dementias . Suspect frontotemporal dementia in an elderly patient who presents with sudden personality change, especially when they demonstrate impulsive and inappropriate behaviors.
Dementia following trauma?
Dementia
pugilistica is a
post-traumatic
dementia that develops after blunt head trauma. The prefix pugil- means boxer in Latin . It often occurs as a result of motor vehicle accident injuries and sports related traumas.
First symptoms of alzheimer’s disease
Typical first symptoms are a subtle
loss of short-term memory
, language difficulties, and apraxias, followed by impaired judgment and
personality changes
.
Psychiatric symptoms
are often prominent in the course of the illness.
What is dementia
Major neurocognitive disorder (previously called dementia) is an acquired disorder of cognitive function that is commonly characterized by impairments in:
memory, speech, reasoning, intellectual function, and/or spatial-temporal awareness.
Most common cause of dementia
Alzheimer disease (>50%) Parkinson disease Frontotemporal dementia Dementia with Lewy bodies Progressive supranuclear palsy Huntington disease
Slowly progressive dementia, featuring episodic impairment of memory and language impairment
Alzheimer disease
What is the characteristic order of language impairment in alzheimers
Naming –> comprehension –> fluency
What is the investigations for alzheimer
AD is a clinical diagnosis
Diffuse cortical atrophy
Hippocampal atrophy.
CSF: reduced beta amyloid, raised phosphorylated Tau
Abrupt cognitive decline and stepwise deterioration with hemiparesis.
Vascular dementia
Investigation for vascular dementia
CT/MRI usually shows lacunar infarcts
Visual hallucinations and steady decline in cognition
Dementia with Lewy bodies (DLB)
What is the investigation for dementia with lewy bodies
SPECT: may reveal decreased occipital perfusion/metabolism
What is the molecule involved in the pathology of dementia with lewy bodies
Lewy bodies (intracellular aggregations of mainly α-Synuclein)
Behavioral variant FTD (most common) leading to early changes in personality, apathy.
Manifesting age 40-69
Frontotemporal dementia (FTD)
A reversible cause of dementia
Normal pressure hydrocephalus, wernicke encephalopathy, pseudodementia
Gait disorder
Dementia
Urinary incontinence
Normal pressure hydrocephalus (wacky, wet and wobbly)
What procedure will alleviate symptoms in normal pressure hydrocephalus
Lumbar puncture
Confusion
Ataxia
Ophthalmoplegia
WE.
Brain finding in chronic WE/WKS
atrophy of the mamillary bodies
rontotemporal dementia, psychosis, cognitive dysfunction, personality changes
Paresis
Argyll Robertson pupil
Tabes dorsalis
Late neurosyphilis
What is pseudodementia
Associated with major depression, especially in elderly patients
Cognitive deficits typically manifest after mood symptoms
Typically sudden onset
What is major depressive disorder
Symptoms are present for at least 2 weeks.
What is persistent depressive disorder
Chronic depression in which depressive symptoms are present ‘more days than not’ over at least a 2-year period (1 year in children and adolescents).
Which sex are at higher risk of developing major depressive disorder and what is the peak age
Women have a higher risk of developing MDD than men. The peak age of onset is the 3rd decade
What is thought to be the aetiology of depressive disorder
Monamine hypothesis: Most antidepressants work by inhibiting the reuptake of monoamines (e.g., serotonin, noradrenaline, dopamine), indicating that a lack of monoamines plays a major role in the pathophysiology of depression (and other mood disorders).
What are the diagnostic features of major depressive EPISODE
5 or more of the 9 symptoms here, for at least 2 weeks. Must include depressed mood/anhedonia.
- Depressed mood for most of the day, almost every day
- Sleep disturbance (insomnia/hypersomnia)
- Anhedonia
- Feelings of worthlessness/disproportionate guilt
- Fatigue or loss of energy
- Diminished concentration, cognition, and ability to make decisions (pseudodementia)
- Weight change due to appetite change
- Psychomotor changes (observed by others)
(Agitation
Retardation) - Suidice ideation.
+
There is clinically significant distress or impaired functioning in important areas of life (e.g., work, school).
+
Symptoms are not due to the effects of psychoactive substances or organic disease.
What is major depressive episode vs major depressive disorder
major depressive disorder is when there is major depressive episode, AND
symptoms are not due to another psychiatric disorder AND there is no history of manic or hypomanic episode
What is persistent depressive disorder
Aka dysthymia
Depressed mood and 2 or more of the following symptoms, for most of the day, for the majority of days for 2 or more years (or 1 or more years for children)
Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness
Diagnosis of depressive disorder
Clinical diagnosis
Assessment of suicide risk
Lab evaluation to rule out organic disease:
-TFTs
-Urine toxicology (to screen for drug use causing depressive symptoms e.g. benzodiazepine withdrawal, amphetamine use, and cocaine “crash”)
-Neuroimaging
In pediatric patients, remember to first rule out organic causes, which are the most common cause of depression in this population.
Elderly patient, major depressive disorder and memory loss
pseudodementia.
T/F pseudodementia is a non-reversible cause of dementia
F
What can you ask patients with pseudodementia
If they remember the onset of symptoms
T/F hallucinations and mood changes are incompatible with alzheimers disease
F
Alzheimer’s disease is the commonest form of dementia and tends to have a gradually progressive course with no lucid intervals. There is memory and cognitive impairment and behavioural changes may occur (apathy, aggression, depression) together with delusions/hallucinations in some patients.
In which dementia type might you get lucid periods
Lewy body dementia is the 3rd commonest type of dementia and is associated with Lewy bodies in the brainstem and cerebral cortex. Lewy bodies are intracytoplasmic neuronal inclusion bodies and may also occur in Parkinson’s disease (where they involve the basal ganglia). In Lewy body dementia lucid periods occur.
T/F subdural is a cause of dementia
No
Parkinsons and hiv infection are
Which drug group would you start with for mild alzheimers? What would you progress to?
The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine as monotherapies are recommended as options for managing mild to moderate Alzheimer’s disease
Memantine monotherapy is recommended as an option for managing Alzheimer’s disease for people with:
- moderate Alzheimer’s disease who are intolerant of or have a contraindication to AChE inhibitors or
- severe Alzheimer’s disease.
