Presentations
- Aspiration pneumonia
- Cognitive decline
- Dysarthria
- Dysphagia
- Dysphasia
- Falls
- Frailty
- Functional decline
- Gait disorders
- Hallucinations, delusions
- Headache
- Localised weakness
- Postural hypotension
- Sensory loss
- Syncope
- Transient ischaemic attacks
- Tremor
- Unsteadiness or imbalance
- Urinary dysfunction, including incontinence
- Visual loss, diplopia
- Weight loss, muscle wasting
Conditions
- Dementia (see KG 2)
- Epilepsy
- Extrapyramidal syndromes
- drug induced Parkinsonism
- idiopathic Parkinson disease
- Parkinson disease plus syndromes (corticobasal degeneration, multisystem atrophy, and progressive supranuclear palsy)
- Motor neurone disease
- Myopathy
- Neuropathy
- Normal pressure hydrocephalus
- Presbycusis
- other sensorineural hearing loss
- Radiculopathy, plexopathy
- Spinal cord compression
- Stroke
- Traumatic brain injury
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Brain tumours
- Central nervous system infection and inflammation
- Chronic inflammatory demyelinating polyneuropathy
- Encephalitis
- Genetic disorders
- Hereditary conditions
- Huntington disease
- Multiple sclerosis
- Muscular dystrophy
- Myasthenia gravis
- Prion disorders
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Localising neurological signs by relating the relevant neuroanatomy
- Neuroanatomical, neurophysiological, neurochemical, and neuropsychological aspects of ageing
- Understand the incidence rates for neurological conditions in the older adult population
Examinations
- Comprehensive geriatric assessment
- Physical examination including full neurological examination
Investigations
- Carotid doppler
- Cerebrospinal fluid (CSF) analysis
- CT scan of the brain / spine
- CT angiogram
- ECG
- EEG
- EMG
- Genetic tests
- MRI and/or magnetic resonance angiography (MRA)
- Muscle and/or nerve biopsy
- Nerve conduction studies
- PET
- SPECT
- Temporal artery biopsy
- Addressing the stigma and discrimination associated with patients who have neurological disorders, and having knowledge of where to refer patients and families and carers for support
- Advance care planning in neurodegenerative conditions
- Behavioural changes associated with neurological disease, including management strategies for family and carers
- Multidisciplinary team involvement for chronic incurable neurological conditions, including:
- dietetics involvement for identification and treatment of malnutrition or obesity
- occupational therapy for advice on equipment and adaptations in the home, and strategies for carrying out daily tasks to retain as much independence as possible
- physiotherapy for movement and balance problems
- speech and language therapy for swallowing and communication difficulties, and consideration of percutaneous endoscopic gastroscopy (PEG) feeding where appropriate
- Neurorehabilitation with an emphasis on restoring function
- Polypharmacy – balancing the need for medications versus the risk of multiple medications, considering toxicity from drug-drug interactions
- Referral to palliative care services where appropriate
- The increased risk of falling or becoming frail
