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NEUROLOGY > Dementia & Cognitive Neurology > Flashcards

Dementia & Cognitive Neurology Flashcards

1
Q

What are the different brain functions which together make up cognition?

A 
Attention
Social Function - i.e. how to act in situations
Language
Executive function - i.e. planning
Memory
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2
Q

What criteria do patients usually meet before a diagnosis of dementia?

A

Cognitive decline in 1 domain (attention, executive, memory, language, praxis, social)

+ deficits interfere everyday activities/ independence

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3
Q

Most patients with dementia are >65 years. TRUE/FALSE?

A

TRUE

BUT dementia is NOT a consequence of ageing

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4
Q

What types of brain insult can cause acute cognitive disorders?

A

Viral encephalitis
Head injury
Stroke

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5
Q

What symptoms are characteristics of transient global amnesia?

A
  • abrupt onset antegrade amnesia => struggle to lay down new memories
  • no retrograde amnesia => preserved self knowledge
  • Transient 4-6 hours (always <24 hours)
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6
Q

What factors are thought to trigger transient global amnesia

A

emotion

changes in temperature

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7
Q

What features characterise transient epileptic amnesia?

A
  • Forgetful / repetitive questioning
  • Carry out complex activities with no recollection
  • Short lived (20 – 30 minutes)
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8
Q

What type of seizure is associated with transient epileptic amnesia?

A

Associated with temporal lobe seizures

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9
Q

What are the potential causes of sub-acute cognitive disorders?

A 
Toxins
Neurodegeneration e.g. CJD
Metabolic: B12
Inflammatory
Mood disorders
Functional
Infection
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10
Q

What is functional cognitive impairment also referred to as?

A

Subjective cognitive impairment

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11
Q

What is functional cognitive impairment?

A
  • patient has everyday forgetfulness that is impacting on functioning
  • However, they can usually hold down a higher functioning job without issue
    => symptom and function mismatch
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12
Q

CJD is a neurodegenerative subacute cognition problem. What is the other name for this condition and why?

A 
Prion disease
(due to defect in prion protein)
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13
Q

What are the 4 main types of Prion disease/CJD?

A

Sporadic
Variant (due to mad cow disease exposure)
Iatrogenic (growth hormone inj. from infected cadavers)
Genetic

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14
Q

What histological change is seen in all types of CJD?

A

Spongiosis

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15
Q

What proteinopathy is responsible for alzheimers dementia?

A

Amyloid protein deposition

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16
Q

Explain what is seen extra- and intra-cellularly in alzheimers dementia?

A 
Extra-cellular = amyloid plaques (disrupt cholinergic pathways)
Intra-cellular = neurofibrillary tangles (tau protein)
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17
Q

Where in the brain does alzheimers degeneration start and progress to? And what symptoms does each cause?

A

Degeneration of:

  • medial hippocampus (forgetfulness)
  • later parietal lobes (apraxia)
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18
Q

What would usually cause an alzheimers presentation before the age of 65?

A
  • Genetic influences (familial)

- atypical presentation

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19
Q

Alzheimers cortical atrophy in this region of the brain causes difficulties in facial recognition and depth perception on stairs etc.

A

Posterior cortical atrophy

20
Q

What are the different types of primary progressive aphasia in alzheimers?

A

Semantic (difficulty naming objects)
Logopenic aphasia (repeating things)
Non-fluent aphasia (staccato speech, difficult for patient)

21
Q

What investigations can be carried out on suspicion of alzheimers and what do these show?

A

MRI: Atrophy of temporal / parietal lobes
SPECT: temporoparietal ↓metabolism
CSF : ↓amyloid as it is in plaques

22
Q

How is Alzheimers disease treated?

A
  • Address vascular risk factors
  • ACh boosting medication
    => Cholinesterase inhibitors (eg Rivastigmine)
    => NMDA receptor blocker (eg Memantine)
23
Q

What age group normally gets Fronto-temporal dementia?

A

Early onset dementia (majority <65 years old)

24
Q

What features do patients with fronto-temporal dementia present with?

A
  • disinhibition
  • loss of empathy
  • compulsive behaviours
  • hyperorality (want to put anything in their mouth, will often continuously eat biscuits/sweet food
  • Early loss of insight
25
Q

What other neurological disease can be linked to fronto-temporal dementia?

A

MND

26
Q

What investigation findings would you expect in fronto-temporal dementia?

A

MRI: Atrophy of frontotemporal lobes

SPECT: Frontotemporal ↓metabolism

CSF: ↑ tau / normal amyloid

27
Q

How are patients with fronto-temporal dementia treated?

A
  • Trial of Trazadone / antipsychotics to help behavioural features
  • Safety management
    => Controlled access to food / money
  • Power of attorney
  • MND nurse specialist if co-existent MND
28
Q

Is vascular dementia early or late onset?

A

Late onset >65 yrs

29
Q

How is vascular dementia diagnosed?

A

1) Presence of cerebrovascular disease

2) Clear temporal relationship between onset of dementia and cerebrovascular disease

30
Q

What are the two main subtypes/causes of vascular dementia?

A

Small vessel disease

Post-stroke

31
Q

How is vascular dementia treated?

A

Manage vascular risk factors

support through community psychiatric nurses

32
Q

Dementia with lewy bodies is caused by what proteinopathy interrupting what pathways?

A

Alpha-synuclein

cholinergic and dopaminergic pathways

33
Q

What age do patient usually develop dementia with lewy bodies?

A

> 65

34
Q

What criteria need to be met for a diagnosis of Dementia with Lewy Bodies?

A 
1) Fluctuating cognition 
AND
2) Visual hallucinations 
\+/-
3)  Extrapyramidal features
35
Q

What investigations are used in Dementia with Lewy Bodies?

A

Investigations: DaT scan (dopamine => used in PD)

New techniques: α-synuclein ligand imaging / α-synuclein in CSF

36
Q

What treatments can be used for dementia with Lewy bodies?

A
  • Small dose Levodopa /↓ acetylcholine
  • trial cholinesterase inhibitors
  • Support: PD nurse specialist / Community psychiatric nurses
37
Q

How are parkinsons dementia and dementia with lewy bodies differentiated?

A

Patients who have had motor parkinsons symptoms for over a year before the start of their dementia are considered to have Parkinson’s dementia

38
Q

Parkinsons dementia and dementia with lewy bodies are managed similarly. TRUE/FALSE?

A

TRUE

39
Q

What are the normal symptoms of huntingtons dementia?

A
  • Dysexecutive syndrome
  • slowed speed of processing
  • memory loss
  • changes in mood / personality
  • later psychosis
40
Q

What feature of Huntingtons disease can be seen on MRI?

A

Loss of Caudate heads

41
Q

How is Huntington’s disease treated?

A
  • Mood stabilisers
  • drugs to reduce chorea
  • nurse specialist
42
Q

Where should dementia patients be referred on to?

A

if >65 and no additional neuro features
=> Old age psychiatry

if <65 and unusual features/additional neurology
=> Neurology referral

43
Q

What blood tests can be considered a “dementia screen” in a neurology clinic?

A 
B12
TFTs
syphilis/HIV
Ca2+ 
genetics
44
Q

What investigations are normally used in a neurology clinic?

A
  • MRI (patterns of atrophy)
  • SPECT imaging (metabolism)
  • CSF (amyloid / tau analysis)
45
Q

What is used to assess cognition in a neurology clinic?

A

Addenbrooke’s Cognitive Assessment

NEUROLOGY (29 decks)

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