15) Dementia and Epilepsy

Question 1

What is dementia?

Answer 1

Progressive decline in higher cortical function leading to global impairment of memory, intellect and personality which affects activities of daily living

Question 2

What are some types of dementia?

Answer 2

Alzheimer’s, fronto-temporal, vascular, dementia with Lewy Bodies

Question 3

What are some reversible causes of dementia?

Answer 3

Depression
Trauma
Vitamin def.
Alcohol
Thyroid disorders

Question 4

What affect does dementia have on memory?

Answer 4

Struggle to learn new information

Short term memory loss

Question 5

What are some behavioural features of dementia?

Answer 5

Altered personality, disinhibition, wandering

Question 6

What are some physical signs in dementia?

Answer 6

Incontinence, difficulty swallowing

Question 7

What investigations can be performed to diagnose dementia?

Answer 7

History and mini-mental state exam
Neurological exam
Blood tests for reversible causes: TFTs, B12
CT/MRI - rule out dementia

Question 8

What is delirium?

Answer 8

Acute confusional state causing decline in mental function

Question 9

What are the points on the conduction assessment method?

Answer 9

Acute change of fluctuating mental state
Altered consciousness
Inattention
Disorganised thinking

Question 10

What might be seen on CT and MRI imaging of someone with dementia?

Answer 10

Dilation of ventricles, generalised atrophy, hippocampal atrophy

Question 11

Describe the cognitive decline in Alzheimer’s disease, vascular and Lewy Body dementia:

Answer 11

Alzheimer’s: constant
Vascular: sudden drops
LB: varying

Question 12

What is pathophysiology behind Alzheimer’s?

Answer 12

Loss of cortical and subcortical white matter causing gyral atrophy and ventricular dilation - due to amyloid beta plaques and neurofibrillary tangles

Question 13

Describe the mild stage of Alzheimer’s:

Answer 13

2-4 years, minor memory loss

Question 14

Describe the moderate stage of Alzheimer’s:

Answer 14

2-10 years, confusion, difficulty in self care, behavioural changes

Question 15

Describe the severe stage of Alzheimer’s:

Answer 15

1-3 years, completely incapacitated, retreat into themselves, don’t recognise people, loss of bodily function, violence

Question 16

Describe the pathophysiology behind Lewy body dementia:

Answer 16

Lewy bodies form in cortex and substiantia nigra causing degeneration

Question 17

What are the features of Lewy body dementia?

Answer 17

Fluctuations in cognitive impairment, Parkinsonism, visual hallucinations, REM sleep behaviour disorder, falls

Question 18

What can be the underlying cause of vascular dementia?

Answer 18

Atherosclerosis of BVs supplying brain

Diffuse small vessel disease infarcts

Question 19

What are some types of frontotemporal dementia?

Answer 19

Frontotemporal lobar degeneration with Tau pathology, Pick’s disease, familial tauopathies

Question 20

What are some of the features of frontotemporal dementia?

Answer 20

Alteration of social behaviour and personality
Agitation 
Depression
Impaired judgement and insight
Mutism

Question 21

How should dementia be managed?

Answer 21

Drugs: cholinesterase inhibitors, memantine
Social care
Memory aids
Therapies - pets, babies

Question 22

What is a seizure?

Answer 22

Sudden, irregular discharge or electrical activity in the brain causing a physical manifestation

Question 23

What is a convulsion?

Answer 23

Uncontrolled shaking movements, rapid, repeated contraction and relaxation

Question 24

What is an aura?

Answer 24

Perceptual disturbance prior to seizure

Question 25

What is epilepsy?

Answer 25

Neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions

Question 26

What is status epilepticus?

Answer 26

Epileptic seizures occurring continuously without recovery of consciousness in between

Question 27

How can seizures be classified?

Answer 27

Partial and generalised

Question 28

What are some examples of partial seizures?

Answer 28

Simple: same consciousness Complex: consciousness impaired

Question 29

Give examples, with a brief description, of generalised seizures:

Answer 29

``` Tonic-clonic: 1st muscles tense, 2nd convulsions Absence: 'day-dreaming', sudden LOC Myoclonic: brief shock like muscle jerks Atonic: drop attack, fall to floor Tonic: increased tone ```

Question 30

What investigations can be done on someone presenting after a seizure?

Answer 30

History, EEG, MRI

Question 31

Describe the key points to ask on a history of someone presenting with a seizure:

Answer 31

Prior to seizure (trigger, aura) During (description, duration) After (post ictal state)

Question 32

What are some differential diagnoses for seizures?

Answer 32

Stroke, meningitis, SLE, hypoxia, electrolyte imbalance, hypoglycemia, alcohol withdrawal