dementia & parkinsons

Question 1

what is dementia

Answer 1

progressive impairment of multiple domains of cognitive function
multiple types
alzheimers is most common type

Question 2

how is dementia diagnosed

Answer 2

PMH
medication - anti-cholinergic
cognitive tests
if there is any doubt refer to neuro for brain imaging

Question 3

what can cause dementia

Answer 3

alcohol 
genetics 
infection 
inflammatory 
VB12 deficiency

Question 4

what are cognitive features of dementia

Answer 4

dysmnesia (memory problems)
dysphasia
dyspraxia
dysexecutive

Question 5

what are some cognitive tests for dementia

Answer 5

MMSE - lower score correlates with poorer ability to preform daily activities
MOCA

Question 6

what are examples of functional impairment in dementia

Answer 6

problems making calls, using computer, driving, taking medications, cleaning, eating/cooking, finances, personal care

Question 7

what can mimic dementia

Answer 7

tumour
hydrocephalus
depression 
chronic subdural bleed
delirium

Question 8

what type of dementia should you be suspicious of if the patient is under 65

Answer 8

alcohol dementia

Question 9

what is alzheimers disease

Answer 9

type of dementia
cause unknown
degeneration, or loss, of neurons in the brain, particularly in the cortex

Question 10

what are risk factors for alzheimers

Answer 10

downs syndrome
family history
hypothyroidism

Question 11

how does alzheimers present

Answer 11

amnesia
disorientation 
personality changes - but personality lasts longer than in other types 
reduction in self care
paranoia 
delusional
aggression 
increased sexuality 
visuospatial problems

Question 12

what are the main features of alzheimers on investigation

Answer 12

amyloid plaques and tau tangles
atrophy
reduction in acetylcholine

Question 13

what investigations could you do in alzheimers

Answer 13

bloods
SPECT
CT
MRI
CSF
EEG
histology - BAT - beta amyloid plaques, decreased ACH, neurofibrillary tangles

Question 14

how do you manage alzheimers

Answer 14

acetylcholinesterase inhibitors:
galantamine
donepezil
rivastigmine

memantine for more severe disease

Question 15

what is vascular dementia

Answer 15

2nd most common type after alzheimers

infarcts of small and medium sized vessels in brain causes damage resulting in dementia symptoms

Question 16

what can vascular dementia follow (3 things)

Answer 16

stroke
multiple strokes
biswanger disease

Question 17

what are features of vascular dementia

Answer 17

focal impairments
cerebrovascular disease on PMH
step wise decline

Question 18

how does vascular dementia present

Answer 18

rapid progression + stepwise decline 
amnesia 
disorientation 
changes in personality 
reduced self care 
depression 
UMN signs 
seizures

Question 19

how would you manage vascular dementia

Answer 19

treat DM and hypertension
aspirin
smoking cessation
support

Question 20

what is dementia with lewy bodies

Answer 20

protein deposits in neurons - alpha synuclein seen on biopsy
associated with parkinsons

Question 21

how does dementia with lewy bodies present

Answer 21

triad
parkinsons
hallucinations
fluctuating course

early visuospatial and executive dysfunction

Question 22

how do you manage dementia with LB

Answer 22

avoid anti-psychotic drugs
levodopa if parkinsons
supportive - falls
DATScan to look at dopamine re-uptake

Question 23

what is huntingtons dementia

Answer 23

complication of huntingtons disease

uncontrollable choreiform movements

Question 24

how does huntingtons dementia present

Answer 24

anxiety
depression
irritibility
OCD 
psychosis

Question 25

how do you manage huntingtons dementia and CJD

Answer 25

no cure | manage symptoms

Question 26

what is creutzfeldt-jakob disease

Answer 26

form of dementia caused by prions very rare causes death

Question 27

how does CJD present

Answer 27

``` rapid progression 4-5months amnesia disorientation psychosis depression personality change ```

Question 28

what is parkinsons disease

Answer 28

proggressive reduction in dopamine in basal ganglia causes disorders of movement lewy bodies can form

Question 29

what are risk factors for parkinsons

Answer 29

``` cause unknown genetics male environmental exposure to pesticides etc dopamine depleting drugs ```

Question 30

how does parkinsons present

Answer 30

``` at least 2 of: bradykinesia rigidity tremor - slow and on rest, unilateral , pin rolling postural instability progression is slow anosmia REM sleep disorder autonomic symptoms - incontinence depression hallucinations facial masking stooped posture forward tilt reduced arm swing shuffling gait parkinsons plus - multiple system atrophy, supranuclear palsy/corticobasal degeneration ```

Question 31

what investigations can you do for parkinsons

Answer 31

dopamine transporter SPECT | CT

Question 32

how would you manage parkinsons

Answer 32

levodopa with carbidopa COMT inhibitors - entacapone dopamine agonists - bromocriptine MAO-B inhibitors - selegiline

Question 33

what is frontotemporal dementia

Answer 33

a type of cortical dementia | picks disease is a subtype

Question 34

what are features of frontotemporal dementia

Answer 34

``` onset before 65 insidious onset memory and visuospatial skills are preserved better personality change social conduct problems ```

Question 35

what are features of picks disease

Answer 35

personality change impaired social conduct disinhibition increased appetite

Question 36

what changes to the brain are seen in picks disease

Answer 36

atrophy of frontal and temporal lobes pick bodies gliosis neurofibrillary tangles