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Flashcards in The ageing brain Deck (45)
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1

What is the importance of the ageing brain in the NHS and in clinical practice?

  • Ageing population with finite NHS resources
  • Social care funding for dependent older adults
  • Impact of neurological disease incl stroke
  • Increasing prevelance + consequence of dementia
  • Influence of delirium on inpatients in hospital

2

What anatomical changes are associated with an ageing brain?

  • Cerebral atrophy
  • Cerebral white matter lesions (leukoaraiosis)
  • Cerebral microhaemorrhages 

3

In whom will cerebral atrophy be most prominent in?

  • More severe in those w dementia esp Alzheimer's
  • More pronounced in hypertensive individuals 

4

Cerebral white matter lesions are a common incidental radiological finding. They are small vessel infarcts/episodes of hypoperfusion. When are they common and what other things are they associated with in patients?

  • Diffuse lesions common in hypertension
  • Associated with vascular risk factors
  • Associated with increased risk of falls, hip fracture, urinary dysfunction, physical functional decline + cognitive impairment.

5

What is the reason for cerebral microhaemorrhages occurring?

  • Cerebral amyloid angiopathy
  • Amyloid deposition in the blood vessels - weakens vessels and gives tendency for bleeding in brain, seen more with advancing age

6

What microscopic changes occur in an ageing brain?

  • Loss of neurons (fewer dendrites + demyelination)
  • Lipofuscin pigment deposition
  • Beta-amyloid plaque
  • Amyloid deposition in blood vessels
  • Neurofibrillary tangles 

7

In terms of functional changes in an ageing brain, what cognitive changes occur?

  • Reduced new memory learning
  • Reduced new problem solving + psychomotor speed
  • Reduced verbal fluency
  • Diminished performance of complex visuospatial tasks
  • Bradyphenia (slow cognition)
  • More cautious pattern of behaviour

8

What are neurological signs of ageing?

  • Long nerve tract reflexes diminished/lost
  • Minor sensory loss distally

Also increased susceptibility to some neuromodulating drugs

9

What is the difference between a stroke and a TIA?

  • Definition of Stroke: “Sudden onset of focal neurological deficit or reduced consciousness that is most likely caused by vascular aetiology and of duration greater than 24 hours (or resulting in death)”.
  • Definition of TIA: “Sudden onset of a focal neurological deficit or monocular dysfunction that is most likely due to vascular aetiology and of symptoms duration less than 24 hours”.

10

What is the epidemiology of stroke?

  • Incidence is 200-250 / 100,000 per year
  • Mean age UK = 74
  • Second commonest cause of death worldwide

11

What are the two main types of stroke?

  • Ischaemic 85%
  • Haemorrhagic 15% 
    -> 10% primary intracerebral haem
    -> 5% subarachnoid haem

12

What are symptoms and signs of stroke?

  • Contralateral weakness (limbs, face)
  • Contralateral sensory loss
  • Contralateral visual field defect
  • Dysphasia
  • Dysarthria (slurred speech)
  • Ataxia
  • Dysphagia
  • Reduced level of consciousness 

13

Which cerebral arteries supply which part of the brain?

14

List the relevant stroke syndromes

  • LACS (Lacunar Stroke Syn) - lenticulostriate arteries, affect basal ganglia
  • TACS (Total Anterior Circulation Syn) - middle cerebral artery, worst one
  • PACS (Partial Anterior Circulation Syn) 
  • POCS (Posterior Circulation Syn) - posterior cerebral artery/vertebral/basilar artery
  • Weber's and Wallenberg's syndromes

15

Describe the prognosis of each of the stroke syndromes

  • TACS - 60% 1 year mortality, 35% dependent
  • PACS - 15% 1 year mortality, 30% dependent
  • LACS - 10% 1 year mortality, 30% dependent
  • POCS - 20% 1 year mortality, 20% dependent

16

What is the most commonly used form of imaging for stroke diagnosis?

CT - quick and easy, tells whether it's a haemorrhage. 

CT scan in very early stages of stroke might be normal so may not show it. 

17

What are risk factors for an ischaemic stroke?

  • Smoking
  • Hypertension
  • Diabetes Mellitus
  • Hypercholesterolaemia 

18

What is the best form of treatment for stroke?

Primary and secondary prevention

19

What are the 2 biggest causes of ischaemic stroke?

  • Atrial fibrilation: atria don't contract properly, ECG shows blood swirling in a circle, blood clot forms -> enters circ -> stroke
     
  • Carotid disease: atherosclerosis occurs in internal carotid -> narrowing -> plaque -> if rupture -> blood clots

20

How do you treat an acute stroke?

  • Antiplatlet 
  • Thrombolysis 
  • Thrombectomy 

21

In which conditions are haemorrhagic strokes prevalent in?

Those with:

  • Hypertension
  • Cerebral amyloid angiopathy

22

How are haemorrhagic strokes managed?

  • Neurosurgery (limited role)
  • Conservative management
  • Blood pressure control
  • Avoidance of antiplatelet/anticoag

23

List different types of Parkinsonism

  • Idiopathic Parkinson's disease
  • Vascular Parkinsonism
  • Parkinson's Plus Syndromes
    -> Progressive Supranuclear Palsy
    -> Multiple System Atrophy
    -> Lewy Body Dementia
  • Drug-induced Parkinsonism
  • MPTP
  • Post-Encephalitic Parkinsonism

24

What physiological and anatomical changes occur in idiopathic Parkinson's Disease?

  • Neuronal loss at substantia nigra
  • Lewy Body deposition
  • Overall reduced dopaminergic neurotransmision in Basal Ganglia

25

Parkinson's Disease is a very slow neurodegenerative disorder. What are the 3 core features (symptoms)?

  • Akinesia
  • Tremor (pill rolling)
  • Rigidity (cog-wheeling)

26

What are other features/symptoms of Parkinson's?

  • Lack of facial expression
  • Parkinsonian gait
  • Micrographia (tiny writing)
  • Depression
  • Constipation (treat w/ laxatives)
  • Sleep disturbance
  • Drooling at mouth

27

In therepeautics of Parkinson's disease, why is Levodopa given with a Decarboxylase inhibitor (eg carbidopa)?

  • Levodopa can cross the BBB - dopamine can't
  • Levodopa becomes dopmine within the brain
  • The carbidopa/decarboxylase inhibitor inhibits peripheral conversion of Levodopa to dopamine
  • Bc peripheral dopamine can cause nausea so prevents nausea + enhances dopamine in CNS

28

Aside from 'levodopa + decarboxylase inhibitor', what other treatments are available for Parkinson's disease?

  • Dopamine agonist
  • Monoamine Oxidase inhibitor 
  • COMT inhibitor
  • Apomorphine
  • Amantadine
  • Deep brain stimulation

29

What are some complications of advanced Parkinson's disease?

  • Falls + serious injury
  • Aspiration pneumonia 

30

What is dementia?

  • Syndrome attributed to disease of the brain
  • Chronic or progressive nature
  • Disturbance of multiple brain functions
  • Present when resultant impact on social/occupational function
  • Consciousness unaltered