Dementia

Question 1

What are Lewy bodies

Answer 1

Eosinophilic, intrcytoplasmic neuronal inclusion bodies

Question 2

Features of Lewy body dementia

Answer 2

fluctuating
Hallucinations (visual)
Parkinsonism
REM sleep disorder

Question 3

What is the most common cause of dementia

Answer 3

Alzheimer’s disease

Question 4

Risk factors for Alzheimer’s

Answer 4

old age
trisomy 21
FH
APP 
ApoE4
head injuries

Question 5

Neurodegenerative proteinopathy in Alzheimer’s disease

Answer 5

B-amyloid plaques extracellularly

Tau neurofibrillary tangles intracellularly

Question 6

Clinical presentation of Alzheimer’s

Answer 6

Memory loss and forgetfulness
chronic / insidious onset
lack of insight
later: difficulty with language, behaviour, depression and orientation

Question 7

Management of Alzheimer’s disease

Answer 7

Mild/mod - AChE inhibitor rivastigmine

2nd line NMDA antagonist memantine

Question 8

What is another name for frontotemporal dementia

FTD

Answer 8

Pick’s disease

atrophy of frontal and temporal lobes

Question 9

What is the onset of FTD

Answer 9

early onset dementia

Question 10

Features of FTD

Answer 10

frontal disinhibition
apathy
loss of insight
changes in character and social deterioration
aphasia: semantic and progressive non-fluent

Question 11

Histological findings in FTD

Answer 11

Pick’s cells - swollen neurons

Pick’s bodies - intracytoplasmic filamentous inclusions

Question 12

What is vascular dementia

Answer 12

cumulative damage to the brain via hypoxia ie successive cerebral infarcts

Question 13

What is Creutzfeldt Jakob disease CJD/Prion disease

Answer 13

neurodegenerative disease with abnormal prion protein

Question 14

What is gold standard investigation of CJD and its finding

Answer 14

Biopsy - spongiform change on histopathology

Question 15

list acute forms of dementia

Answer 15

transient global amnesia 
transient epileptic amnesia 
viral encephalitis 
trauma 
stroke

Question 16

what is transient global amnesia

Answer 16

acute anterograde amnesia preserved knowledge of self

lasts 4-6 hours

Question 17

what is transient epileptic amnesia

Answer 17

episodic isolated memory loss associated with temporal lobe seizures with response to AEDs

Question 18

Prion disease is an acute/subacute/chronic cognitive disorder

Answer 18

subacute

Question 19

what is the most common human prion disease

Answer 19

Creutzfeldt-Jakob disease

Question 20

what is CJD

Answer 20

neurodegenerative proteinopathy

Question 21

how many abnormal prions are needed for a harmful effect

Answer 21

1

domino effect

Question 22

what are the 4 subtypes of CJD

Answer 22

sporadic
variant
iatrogenic
genetic

Question 23

of which protein is there neurodegenerative proteinopathy in Alzheimer’s disease

Answer 23

amyloid

Question 24

which pathways are disrupted in Alzheimer’s

Answer 24

cholinergic

Question 25

which investigations can be carried out in Alzheimer's

Answer 25

MRI - atrophy SPECT - reduced metabolism CSF - reduced amyloid and increased tau protein

Question 26

of which protein is there neurodegenerative proteinopathy in FTD

Answer 26

tau

Question 27

which other neurological disease can FTD be a part of

Answer 27

MND

Question 28

investigations and findings for FTD

Answer 28

MRI - frontotemporal lobe atrophy SPECT - decreased metabolism CSF - increased tau, normal amyloid

Question 29

what is vascular dementia

Answer 29

gradual cognitive disorder with presence of cerebrovascular disease

Question 30

there is stepwise/gradual decline in vascular dementia

Answer 30

stepwise

Question 31

of which protein is the neurodegenerative proteinopathy in DLB

Answer 31

a-synuclein

Question 32

which pathways are disrupted in DLB

Answer 32

cholinergic and dopaminergic

Question 33

DLB can worsen with neuroleptics such as haloperidol, true or false

Answer 33

true | haloperidol should never be given in parkinsonism

Question 34

investigations in DLB

Answer 34

DaTSPECT scan a-synuclein ligand imaging a-synuclein CSF

Question 35

management of DLB

Answer 35

small dose levodopa trial anticholinesterases support

Question 36

core criteria of DLB

Answer 36

fluctuating cognition recurrent well formed visual hallucination presence of extrapyramidal features also neuroleptic sensitivity

Question 37

what is the difference between DLB and PD dementia

Answer 37

in someone with PD: dementia within 1 year of presentation = DLB dementia after 1 year of presentation = PDD

Question 38

triad of features in huntington's disease

Answer 38

emotional cognitive motor

Question 39

management of Huntington's disease

Answer 39

mood stabilisers treatment for chorea nurse specialist

Question 40

who do you refer >65 yo with gradual onset dementia with no additional neurology to?

Answer 40

old age psychiatry

Question 41

who do you refer <65 yo with unusual features of dementia to

Answer 41

neurology

Question 42

what is the dementia screen for blood tests

Answer 42

``` B12 folate TFT syphilis HIV Ca genetics ```

Question 43

of which protein is there neurodegenerative proteinopathy in huntington's disease

Answer 43

huntington protein

Question 44

CSF of Alzheimer's: | there is high/low B amyloid and high/low Tau

Answer 44

low B amyloid | high Tau

Question 45

what kind of stroke are patient with Alzheimer's disease at risk of and why

Answer 45

Haemorrhagic stroke | B-amyloid deposits (cerebral amyloid angiopathy)