Degenerative Diseases of CNS

Question 1

what is dementia?

Answer 1

progressive impairment of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interface in occupational and social role

Question 2

what are the 3 most common causes of late onset dementia?

Answer 2

> alzheimers
vascular
lewy body

Question 3

what are the 3 most common causes of dementia in young onset?

Answer 3

> alzheimers
vascular
fronototemporal

Question 4

name a genetic cause of young onset dementia

Answer 4

huntingtons

Question 5

what infections can cause dementia?

Answer 5

> HIV

> CJD

Question 6

what inflammatory conditions cause dementia?

Answer 6

MS

Question 7

what are some treatable conditions of dementia?

Answer 7

> B12 deficiency
thyroid disease
HIV
syphilis

Question 8

what conditions can mimic dementia?

Answer 8

> hydrocephalus
tumour
depression

Question 9

how is dementia diagnosed?

Answer 9

> history from independent witness
examination of cognitive function, neurological and vascular
blood, CT/MRI investigations

Question 10

what investigations would you carry out for dementia?

Answer 10

> bloods
> CT/MRI
(> CSF
>EEG
> functional
> genetics)

Question 11

name 2 cognitive function screening tests

Answer 11

> mini-mental (MMSE)

> montreal (MOCA)

Question 12

what clues are there to diagnoses of dementia?

Answer 12

> type of cognitive deficit
> speed of progression
> abnormal movements (huntingtons)
> parkinsons (lewy body)
> myoclonus (CJD)

Question 13

how does CJD dementia progress?

Answer 13

rapidly

Question 14

how does vascular dementia progress?

Answer 14

stepwise

Question 15

what is the commonest neurodegenerative condition?

Answer 15

alzheimer’s disease

Question 16

describe the dementia in alzheimer’s

Answer 16

> temporo-parietal disturbance
early memory disturbance
language and visuospatial problems
personality preserved until later

Question 17

describe fronto-temporal dementia

Answer 17

> early change in personality
change in eating habits
early dysphasia
memory/visuospatial relatively preserved

Question 18

how does vascular dementia decline?

Answer 18

stepwise

Question 19

what non-pharmacological symptomatic treatment is there for dementia?

Answer 19

> information and support
OT
social support
voluntary organisations

Question 20

what symptoms can you treat pharmacologically for dementia?

Answer 20

> insomnia
behaviour
depression

Question 21

what specific treatment is there in alzheimers?

Answer 21

> cholinesterase inhibitors (donepezil)

> NMDA antagonist

Question 22

name some clinical signs that are present in parkinsonism

Answer 22

> bradykinesia (slowness of movement)
rigidity (stiffness)
tremor (shakiness)
postural instability (unsteadiness/falls)

Question 23

in parkinsonism what neurotransmitter is lost?

Answer 23

dopamine

Question 24

name some causes of parkinsonism

Answer 24

> idiopathic dementia with lewy bodies
> drug induced
> vascular
> multiple system atrophy
> progressive supranuclear palsy

Question 25

describe the clinical diagnosis of parkinsonism

Answer 25

> bradykinesia with tremor, rigidity or postural instability > slow progression > supported by asymmetric rest tremor and good response to dopamine replacement treatment

Question 26

what imaging is used to view the basal ganglia in parkinsonism?

Answer 26

dopamine transporter SPECT

Question 27

name 4 early medication treatment in parkinsons

Answer 27

> levodopa > COMT inhibitor > MAO-B inhibitor > dopamine agonists

Question 28

what drug stops levodopa being converted to 3OMD?

Answer 28

COMT inhibitor

Question 29

what does levodopa become in the synaptic terminal?

Answer 29

L-DOPA

Question 30

what is the action of MAO-B inhibitor?

Answer 30

it converts dopamine to DOPAC

Question 31

what are some drug induced later complications of parkinsons?

Answer 31

> motor fluctuations as levodopa wears off > dyskinesias > psychiatric (hallucinations, impulse control)

Question 32

name some non-drug induced later complications of parkinsons

Answer 32

``` > depression > dementia > autonomic > speech > balance ```

Question 33

what drugs prolong the levodopa half life?

Answer 33

> MAO-B inhibitors > COMT inhibitors > slow release levodopa

Question 34

what is the late treatment for parkinsons?

Answer 34

> drugs-oral dopamine agonist, continuous infusion > functional neurosurgery > allied health professionals