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Year 4 - Special Senses > Neurology - Memory Impairment > Flashcards

Neurology - Memory Impairment Flashcards

1
Q

Most common cause of dementia in the UK.

A
  1. Alzheimer’s disease
  2. Vascular dementia
  3. Lewy body dementia
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2
Q

Assessment tools recommended by NICE for dementia screening.

A
  • 10 point cognitive screener (10-CS)
  • 6-item cognitive impairment test (6-CIT)
  • Mini-Cog
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3
Q

6-CIT test for dementia screening.

A
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4
Q

An MMSE score of __ out of 30 suggests dementia.

A

<24

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5
Q

Reversible causes of memory decline.

A
  • hypothyroidism (TFTs)
  • anaemia & infection (FBC)
  • U&Es (uraemia, AKI)
  • hypercalcaemia (calcium)
  • hypoglycaemia (glucose)
  • hyperbillirubinaemia (LFTs)
  • B12 / folate deficiency
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6
Q

Risk factors for Alzheimer’s disease.

A
  • increasing age
  • family history of Alzheimer’s disease
  • Down’s syndrome
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7
Q

Macroscopic changes seen in Alzheimer’s disease.

A

Widespread cerebral atrophy, particularly involving the cortex and hippocampus.

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8
Q

Microscopic changes seen in Alzheimer’s disease.

A

Hyperphosphorylation of tau protein results in deposition of beta-amyloid plaques and neurofibrillary tangles.

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9
Q

Biochemical changes seen in Alzheimer’s disease.

A

Deficit of acetylcholine.

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10
Q

Non-pharmacological management of Alzheimer’s disease.

A

Say you will write to patient’s GP and get social prescriber involved.

  • NICE recommend offering ‘a range of activities to promote wellbeing that are tailored to the person’s preference’
  • NICE recommend offering group cognitive stimulation therapy for patients with mild and moderate dementia
  • other options to consider include group reminiscence therapy and cognitive rehabilitation
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11
Q

First line treatment for Alzheimer’s disease.

A

Acetylcholinesterase inhibitors.

Donepezil; Galantamine; Rivastigmine

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12
Q

Second line treatment for Alzheimer’s disease.

A

Memantine (NMDA receptor antagonist) used instead of or in adjunct to acetylcholinesterase inhibitors.

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13
Q

Should you prescribe antidepressants for moderate depression in patients with dementia?

A

No - NICE do not recommend.

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14
Q

Should you prescribe antipsychotics in Alzheimer’s dementia?

A

Only use when patients are at high risk of harming themselves or others.

Or where distress is severe.

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15
Q

Contraindications of donepezil.

A

Bradycardia

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16
Q

Adverse effects of donepizil.

A

Insomnia

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17
Q

Subtypes of vascular dementia.

A
  • stroke related BD (multi-infarct)
  • subcortical VD (small vessel disease)
  • mixed dementia (VD + alzheimers)
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18
Q

Risk factors for vascular dementia.

A
  • history of stroke / TIA
  • atrial fibrillation
  • hypertension
  • diabetes mellitus
  • hyperlipidaemia
  • smoking
  • obesity
  • coronary heart disease
  • family history of stroke / cardiovascular disease
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19
Q

Presentation of VD.

A

Several months of years of a history of sudden or stepwise deterioration of cognitive function:
- visual disturbance, sensory or motor symptoms
- difficulty with attention / concentration
- seizures
- memory disturbance
- gait disturbance
- speech disturbance
- emotional disturbance

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20
Q

Non-pharmacological management of VD.

A

Tailored to the individual

Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy

Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication

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21
Q

Pharmacological management of VD.

A

No specific pharmacological management of VD - no evidence aspirin is effective.

Only consider AChE inhibitors or memantine for people with VD + comorbid dementia.

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22
Q

Pathophysiology of Lewy-Body dementia.

A

Lewy body deposition in:
- substantia nigra
- paralimbic areas
- neocortical areas

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23
Q

Features of Lewy body dementia (LBD).

A
  • progressive cognitive impairment
  • fluctuating cognition
  • parkinsonism
  • visual hallucinations
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24
Q

How is Lewy body dementia and Parkinson’s disease dementia differentiated?

A

Parkinson’s disease dementia: motor symptoms present for at least one year before cognitive symptoms.

LBD: cognitive impairment typically occurs before Parkinsonism

25
Q

Diagnosis of Lewy body dementia.

A
  • usually clinical
26
Q

Management of LBD.

A
  1. Acetycholinesterase inhibitors (rivastigmine, donepizil)
  2. NMDA antagonist (memantine)
27
Q

What drugs are contraindicated in Lewy body dementia?

A

Neuroleptics (e.g. haloperidol) - as patients are extremely sensitive and may develop irreversible Parkinsonism.

28
Q

What is frontotemporal lobar degeneration?

A

Third most common type of cortical dementia.

29
Q

Types of FTLD.

A
  • frontotemporal dementia (Pick’s disease)
  • chronic progressive aphasia (CPA)
  • semantic dementia
30
Q

Common features of FTLD.

A
  • onset before 65
  • insidious onset
  • relatively preserved memory and visuospatial skills
  • personality change
  • social conduct problems
31
Q

Macroscopic changes seen in Pick’s disease.

A
  • atrophy of frontal and temporal lobes
32
Q

Microscopic changes seen in Pick’s disease.

A
  • Pick bodies
  • gliosis
  • neurofibrillary tangles
  • senile plaques
33
Q

Features of Pick’s disease.

A
  • personality change
  • impaired social conduct
  • hyperorality
  • disinhibition
  • increased appetite
  • perseveration behaviour
34
Q

Management of Pick’s disease.

A

Do NOT recommend AChE inhibitors or memantine.

35
Q

Pathophysiology of Parkinson’s disease.

A

Progressive degeneration of dopaminergic neurons in the substantia nigra, resulting in reduced dopamine output.

36
Q

Triad of features of Parkinson’s disease.

A
  • bradykinesia
  • tremor
  • rigidity
37
Q

Features of Parkinson’s disease - bradykinesia.

A
  • poverty of movement also seen, sometimes referred to as hypokinesia
  • short, shuffling steps with reduced arm swinging
  • difficulty in initiating movement
38
Q

Features of Parkinson’s disease - tremor.

A
  • most marked at rest, 3-5 Hz
  • worse when stressed or tired, improves with voluntary movement
  • typically ‘pill-rolling’, i.e. in the thumb and index finger
39
Q

Features of Parkinson’s disease - rigidity.

A

Lead pipe rigidity: constant resistance to motion throughout entire range of movement.

Cogwheel rigidity: resistance that stops and starts as the limb is moved through its range of motion.

40
Q

Psychiatric features associated with Parkinson’s disease.

A
  • depression
  • dementia
  • psychosis
  • sleep disturbance
41
Q

Autonomic dysfunction associated with Parkinson’s disease.

A
  • postural hypotension
42
Q

Drug-induced parkinsonism has slightly different features to Parkinson’s disease.

A
  • motor symptoms are generally rapid onset and bilateral
  • rigidity and rest tremor are uncommon
43
Q

If there is difficulty differentiating between essential tremor and Parkinson’s disease, NICE recommend which imaging/

A

Single photon emission computed tomography (SPECT)

44
Q

First line treatment of Parkinson’s disease

a) troublesome motor symptoms

b) no motor symptoms that are troublesome

A

a) levodopa

b) dopamine agonist, MAO-B inhibitors

45
Q

Adverse effects of medications used to treat Parkinson’s disease.

A
  • excessive sleepiness
  • hallucinations
  • impulse control disorders

Levodopa and MOA-B inhibitors usually better tolerated than dopamine antagonists.

46
Q

If a patient with Parkinson’s disease continues to have symptoms despite optimal levodopa treatment, what do NICE recommend?

A

Addition of:
- MAO-B inhibitor
- COMT inhibitor
- dopamine agonist

47
Q

What is co-prescribed with levodopa?

A

Decarboxylase inhibitor (e.g. carbidopa).

Prevents the peripheral metabolism of levodopa to dopamine outside of the brain, therefore reduced the side effects.

48
Q

Common side effects of levodopa.

A
  • dry mouth
  • anorexia
  • palpitations
  • postural hypotension
  • psychosis
49
Q

Risk of acutely stopping levodopa.

A

Acute dystonia.

If the patient cannot take medication orally, they can be given a dopamine agonist patch as rescue medication.

50
Q

What is an acute dystonia?

A

Acute withdrawal of dopamine results in painful and involuntary muscular contractions.

51
Q

Causes of acute dystonias.

A
  • acutely stopping levodopa
  • antidopaminergic agents
  • dopamine receptor antagonsits (e.g. metoclopramide, haloperiodol)
52
Q

Treatment of acute dystonia.

A
  • urgent senior input
  • IV medication (benzodiazepines and anticholinergics)
  • terminate or reduce triggering medication
53
Q

What is the role of anti-muscarinics in Parkinson’s disease?

A

Block cholinergic receptors to help tremor and rigidity.

Usually used to treat drug-induced Parkinsonism rather than idiopathic Parkinson’s disease.

54
Q

What medication can be prescribed to manage salivation in Parkinson’s?

A

Glycopyrronium bromide.

55
Q

Causes of thiamine deficiency.

A

Alcoholism most common.

Rarer causes include:
- persistant vomiting
- stomach cancer
- dietary deficiency

55
Q

What is Wernicke’s encephalopathy?

A

Neuropsychiatric disorder caused by thiamine deficiency.

56
Q

Classic triad of Wernicke’s encephalopathy.

A
  • nystagmus
  • gait ataxia
  • encephalopathy (ie. confusion, disorientation, inattentiveness)
57
Q

Treatment of Wernicke’s encephalopathy.

A

Urgent replacement of thiamine.

58
Q

Relationship between Wernicke’s encephalopathy and Korsakoff syndrome.

A

Korsakoff syndrome - untreated Wernicke’s can result in permanent antero- and retrograde amnesia, plus confabulation.

Year 4 - Special Senses (18 decks)

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