COTE (OC)

Question 1

How does frontotemporal dementia usually present?

Answer 1

1. gradual onset personality changes
2. Memory and visuospatial skills remain

Question 2

In vascular dementia what is seen in the progress of the patient’s condition?

Answer 2

Since it is based on mini-strokes, patient will have sudden mini decreases in health

Question 3

What might we see in lewy body dementia?

Answer 3

1. Motor symptoms over memory loss
2. Freindly hallucinations
3. Tremor/shuffle gaint (similar to parkinsons)

Question 4

What medication classes are used for dementia (give examples)

Answer 4

1. Cholinesterase inhibitors
   (donepezil, rivastigmine galantamine,)
2. NMDA antagonists
   (memantine) (like ketamine)
   (stops uptake of calcium from blocking glutamate)

Question 5

Way to remember the cholinesterases?

Answer 5

Riva(stigmine) in Don(epezil) eGala(ntamine)

Question 6

What is olanzapine?

Answer 6

An antipyschotic (2nd gen)

Question 7

What considerations are there with antipsychotics & dementia?

Answer 7

1. Increases risk of mortality
2. Only to be used with patients at high risk of harming themselves

Question 8

The term lewy body dementia covers two types of dementia? What are they

Answer 8

1. Parkinson’s dementia
2. Dementia with lewy bodies

Question 9

What is the difference between parkinsons dementia and dementia with lewy bodies?

Answer 9

Parkinsons dementia is when the memory and thinking issues come on a year later than the movement issues

Whereas D w/ LB sametime with parkinsons

Question 10

what is amaurosis fugax?

Answer 10

sudden loss of vision in one or both eye(s), caused by an infarct in the retinal artery(ies).
classically - curtain coming down.

Question 11

give three adverse effects due to the difficulty in achieving steady dose of levodopa for Parkinson’s

Answer 11

1. combined with decarboxylase inhibitor (e.g. carbidopa)
2. dyskinesia at peak dose (writhing movements),
3. on-off effect, large variation in motor performance

Question 12

list some alternative drugs (i.e. not L dopa) for Parkinson’s treatment

Answer 12

1. MAO-B inhibitors (stops MAO from recycling old dopamine)
2. COMT Inhibitors (similarly needed like decarboxylase inhibs to prevent peripheral breakdown)
3. Dopamine agonists

Question 13

what possible side effects might you see in a patient on a dopamine receptor agonist?
(e.g. bromocriptine, ropinirole, cabergoline, apomorphine)

Answer 13

1. impulse control disorders
2. excessive daytime somnolence
3. hallucinations in older people

(also: nasal congestion, postural hypotension)