Dementia and Parkinson's

Question 1

Classic triad of Parkinsons

Answer 1

Resting tremor
Bradykinesia
Rigidity

Question 2

Parkinsons pathophysiology

Answer 2

Reduction of dopamine in basal ganglia

Question 3

How do symptoms present in Parkinsons (not the specific symptoms)

Answer 3

Asymmetrically

One side is normally worse than the other

Question 4

What is basal ganglia responsible for

Answer 4

Coordinating movements

Question 5

Where is the substantial nigra and what does it do

Answer 5

Part of the basal ganglia that produce dopamine

Question 6

Typical demographics of a parkinsons patient

Answer 6

70M

Question 7

Describe Parkinsonian tremor and how it may change

Answer 7

4-6hz - pill rolling

Tremor is worsened if patient is distracted
For example asking them do a movement in the other hand

Question 8

How is a benign essential tremor affected at rest

Answer 8

Improves

Parkinson’s worsens at rest but improves with intentional movement

Question 9

How does a benign tremor change with alcohol

Answer 9

Improves

Question 10

What type of dementia is associated with Parkinsons

Answer 10

Lewy body

Question 11

Key drugs for Parkinsons and how do they work

Answer 11

Co-……..-Dopa

Synthetic dopamine with a decarboxylase inhibitor to stop domaine being broken down

Can also use COMT inhibitors, dopamine agonists (pulmonary fibrosis), and monoamine oxidase B inhabitors

Question 12

Drug of choice for delirium tranquillisation

Answer 12

Haloperidol

Question 13

Memory loss features in dementia

Answer 13

Short term more effected than long term

Question 14

5 key types of dementia

Answer 14

AD
D with Lewy bodies
Huntingtons
Picks disease and frontotemporal

Vascular
(Other secondary causes)

Question 15

Most common form of dementia

Answer 15

AD (50%)

Question 16

Risk factors for AD

Answer 16

Female sex
FH
Downs syndrome
Head injury

Question 17

Key pathophysiology of AD

Answer 17

Formation of amyloid plaques
Cortical atrophy
Senile plaques and neurofibrillary tangles

Question 18

Second most common cause of Dementia

Answer 18

D with Lewy bodies (20%)

Question 19

What are Lewy bodies

Answer 19

Alpha-synuclein cytoplasmic inclusions

Question 20

Key feature for Lewy body dementia

Answer 20

Early impairments in attention (rather than just memory in comparison to AD)

Features of Parkinson’s
Visual hallucinations

Question 21

Type of scan to diagnose Lewy body dementia

Answer 21

SPECT scan

Question 22

What drugs should be avoided in a patient with Lewy body dementia having visual hallucinations

Answer 22

Anti-psychotics!!

Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer’s

Question 23

Drug treatment for Lewy body dementia

Answer 23

Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer’s

Question 24

NICE recommended assesment tool for cognitive impairment and dementia screening

Answer 24

10-CS (cognitive screen)

GPCOG and MMSE (score of less than 24/30)

Question 25

Risk factors for Picks disease

Answer 25

Age 45-60 years Female Scandinavian?

Question 26

Neuropathology changes since in Picks disease

Answer 26

'knife blade' atrophy affecting frontal and temporal lobes Pick bodies

Question 27

Clinical features of Picks disease

Answer 27

Frontotemperal dementia Insidious and progressive dementia with very prominent personality changes hyperorality (examine objects by mouth), disinhibition and increased appetite

Question 28

Commonest cause of delirium

Answer 28

Drugs (not infection!)

Question 29

Key way to differentiate delirium and dementia

Answer 29

Consciousness (impaired in delirium) Onset time Course (delirium fluctuates)

Question 30

1st line class of drug in AD and DLB

Answer 30

Cholinesterase inhibitor (donepezil, rivastigmine galantamine)

Question 31

What is Picks disease

Answer 31

FT dementia

Question 32

Which type of dementia is the most rapidly progressing

Answer 32

DLB | Death common within 7 years

Question 33

visual hallucinations and Parkinson-like symptoms -> dx

Answer 33

DLB

Question 34

Differentiating DLB with Parkinsons

Answer 34

Parkinsons physical symptoms come first

Question 35

Dementia under 65 -> dx

Answer 35

FT dementia | CJD

Question 36

What dementia is associated with MND

Answer 36

FT

Question 37

Dementia most associated with visual hallucinations

Answer 37

DLB | Can be in late vascular

Question 38

rapid onset dementia and myoclonus

Answer 38

CJD