A 69-year-old man who is known to have Alzheimer's disease is reviewed in clinic. His latest Mini Mental State Examination (MMSE) score is 18 out of 30.
What is the most appropriate management?
Correct Answer E:
Alzheimer's disease:
Alzheimer's disease is a progressive degenerative disease of the brain accounting for the majority of dementia seen in the UK.
Genetics:
Pathological changes:
Neurofibrillary tangles:
Management:
A 76-year-old man is reviewed in the Elderly Medicine clinic. He is concerned about his increasing forgetfulness over the past six months. His daughter notes he has generally 'slowed down' and struggles to follow conversations. Over the past month he has noted increasingly frequent episodes of urinary incontinence. He has also had one episode of faecal incontinence in the past week. On examination he is noted to have brisk reflexes and a short, shuffling gait. No cerebellar signs are noted.
What is the most likely diagnosis?
Correct Answer C: Urinary incontinence + gait abnormality + dementia = normal pressure hydrocephalus.
The presence of dementia and absence of cerebellar signs point away from a diagnosis of multiple system atrophy.
Normal pressure hydrocephalus:
Normal pressure hydrocephalus is a reversible cause of dementia seen in elderly patients. It is thought to be secondary to reduced CSF absorption at the arachnoid villi. These changes may be secondary to head injury, subarachnoid haemorrhage or meningitis.
A classical triad of features is seen:
A 55-year-old man is diagnosed with amyotrophic lateral sclerosis.
Which one of the following drugs has been shown to confer a survival benefit?
Correct Answer B:
Motor neuron disease: management:
Motor neuron disease is a neurological condition of unknown cause which can present with both upper and lower motor neuron signs. It rarely presents before 40 years and various patterns of disease are recognized including amyotrophic lateral sclerosis, progressive muscular atrophy and bulbar palsy.
Riluzole:
Respiratory care:
Prognosis:
Which one of the following is least associated with the development of chorea?
Correct Answer A:
Chorea:
Chorea describes involuntaru, rapid, jerky movements which often move from one part of the body to another.
Slower, sinuous movement of the limbs is termed athetosis. Chorea is caused by damage to the basal ganglia, especially the caudate nucleus.
Causes of chorea:
A 33-year-old female with multiple sclerosis complains that her vision becomes blurred during a hot bath.
What is this an example of?
Correct Answer A: This is Uhthoff's phenomenon. Lhermitte's sign describes paraesthesiae in the limbs on neck flexion.
Oppenheim's sign is seen when scratching of the inner side of leg leads to extension of the toes. It is a sign of cerebral irritation and is not related to multiple sclerosis.
Werdnig-Hoffman's disease is also known as spinal muscular atrophy.
Multiple sclerosis: features:
Visual:
Sensory:
Motor:
Cerebellar:
Others:
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