Dementia, Parkinsons, MS Flashcards
(27 cards)
1.Occurs at Rest and Improves with Movement ?
- Worsen’s as the target approaches?
- Think, Parkinson’s disease
- Intention Tremor, Cerebella Tremor
What medications are approved for moderate to severe Alzheimer disease?
Donepezil, Rivastigmine (AChE inhibitors) and Memantine (NMDA antagonist)
Memantine works by regulating glutamate activity, which is involved in learning and memory.
- What is the treatment of choice for Dementia with Lewy bodies?
- What should be avoided in Dementia with Lewy bodies?
- Ach- Inhibitors
- First-generation Antipsychotics
First Gen: Chlorpromazine, Fluphenazine, Haloperidol, Loxapine, Perphena
These medications can help manage cognitive symptoms and may also aid in treating associated behavioral symptoms.
What is the main treatment for Vascular Cognitive Impairment?
Risk factor modification + acetylcholinesterase inhibitors
Addressing vascular risk factors is crucial for prevention and management.
What may help Compulsive Behaviors in Frontotemporal Dementia?
SSRIs
Selective serotonin reuptake inhibitors can mitigate certain behavioral symptoms.
What is the first-line treatment for behavioral symptoms in dementia?
Nonpharmacologic interventions
These strategies should be prioritized before considering medications.
What is the preferred treatment for Depression in patients with Dementia?
SSRIs
SSRIs are generally well-tolerated and can help manage depressive symptoms.
- Classic Triad
- Fluctuating cognition
- Visual hallucinations
- Parkinsonian motor features
The motor features and dementia occur within 1-2 years of eachother
Additional supportive features:
* REM sleep behavior disorder
* Severe sensitivity to Antipsychotics (worsened symptoms with Haloperidol)
- Rx?
- Dementia with Lewy Body
- Rivastigmine (Acetylcholinesterase inhibitor) - like Alzheimers Dz
Often presents before age 65 and misdiagnosed as psychiatric illness
* Disinhibition * Apathy or emotional blunting * Hyperorality (e.g., sweet cravings) * Loss of empathy * Relatively preserved memory early on
Behavioral issues show up first !!!!!
Dx?
What Rx doesnt work?
What can you use?
Behavioral Variant Fronto-Temporal Dementia
CT Scan - Frontal and Anterior Temporal Atrophy
-Behavioral issues First , NO Memory Until Later….Difference from Alzheimers
-Cant use Acetycholinesterase inhibitors because its not an Acetycholine issue
NO Disease-modifying treatments,
-SSRIs may help manage Behavioral symptoms.
*. Gait disturbance (usually first and most prominent; “magnetic” gait)
* Urinary incontinence
* Cognitive impairment (often frontal/executive)
- Dx:
- Next Step In management?
- What does the Imaging generally show?
- What will be helpful in predicting a response to VP shunt placement?
- Normal Pressure Hydrocephalus
- Do CT Head than LP
- CT Head- Ventriculomegaly without cortical atrophy- supports diagnosis
- High Volume LP can help predict if VP shunt will be helpful
- Perform a large-volume lumbar puncture with symptom assessment before and after
SSRIS and Antipsychotics for behavioral modification
- What is Transverse Myelitis?
- The Symptoms ?
- What is found on imaging?
- How is the spinal cord different from MS?
- First treatment?
- Next treatment if thats not succesful?
What condition presents with recurrent optic neuritis and longitudinally extensive transverse myelitis, but no brain lesions?
Neuromyelitis optica (NMO) aka Devic disease
check AQP4-IgG (NMO-IgG)
What CSF and MRI findings distinguish Idiopathic Transverse Myelitis from MS?
Trans Verse Myelitis has
1. Normal Brain MRI
2. No Oligoclonal Bands AND No IgG index elevation
What Vitamin deficiency causes Paraparesis, Sensory Ataxia, and Paresthesias — but may LACK Anemia?
What labs to check in B12 if Borderline Levels?
Vitamin B12 deficiency
Remember Folic only RAISES Homo Check MMA & homocysteine if labs are borderline!
What mimics B12 deficiency and is often seen after bariatric surgery or excess zinc intake?
Copper deficiency
What Spinal Cord Condition presents with Sudden Flaccid Paralysis and Pinprick sensation loss?
Spinal Cord Infarction
Sudden Loss!
often due to emboli, hypotension, or AVMs
- What is the first test to order for suspected Spinal Cord Compression?
- What’s the emergency treatment for spinal cord compression from metastasis?
3.When should you avoid glucocorticoids in spinal cord compression?
1.MRI of the spine
- High-dose glucocorticoids, then surgery + radiation
- In cases of infection or hematoma — can worsen outcomes!
Fever + spinal cord symptoms = ?
Epidural abscess
On anticoagulation + acute spinal symptoms = ?
Epidural hematoma
Is there a treatment for spinal cord infarction?
❌ No specific treatment — supportive only
What are nonmotor symptoms that can suggest early Parkinson’s disease?
REM sleep behavior disorder, excessive daytime somnolence, mood disturbances, anosmia, constipation
These symptoms may appear before the onset of motor symptoms.
True or False: Nonmotor symptoms only occur after the onset of motor symptoms in Parkinson’s disease.
False
Nonmotor symptoms can manifest before motor symptoms.
Fill in the blank: _______ is a nonmotor symptom that may indicate early Parkinson’s disease.
REM sleep behavior disorder
Which nonmotor symptom is characterized by a reduced sense of smell?
Anosmia
