Professor Matthew Kiernan

But for instance, at nighttime, when they get up in the middle of the night, they fall over.

So that's a way to try and look at that, and coordination testing in a general sense.

Reflexes are used for us to try to determine the level of – we use a word called lesion.

Where is the lesion?

So we're trying to work out where the abnormality is.

And by tradition, we divide the nervous system up into central, which is the brain and the spinal cord, or we call it upper motor neuron, or there's the peripheral, and that's the nerve and muscles in the arms and the legs.

And reflexes tell us where to go.

So in other words, if I test someone and they've got very brisk reflexes in a territory, so I just tap them or I don't even need a tendon hammer, that's suggesting upper motor neuron or central problems.

If I test their reflexes and I've got no reflexes in a region, that would suggest that the nerve supply is damaged.

So, that's a peripheral abnormality.

So, we're trying to see, is this a central problem, like vascular dementia, or is it a peripheral problem, like a diabetic neuropathy?

Yeah.

So...

It really depends on what the patient is presenting with.

But let's say the presentation might be a partner's things that they're not thinking as well as they were or there's a family history.

And with family history, we use typically under the age of 50.

So if someone has had family members had either a heart attack or a stroke under 50, that's significant.

And so as part of my assessment, we do investigations.

And the Doppler study is an ultrasound looking at the carotid and vertebral arteries.

They're the main blood vessels that go to the brain, supplying from the heart directly.