Degenerative diseases Flashcards
What are the common features of degenerative diseases?
- Unknown aetiology
- Late onset
- Gradual progression
- Neuronal loss
- Normal structural imaging
What is dementia?
Progressive impairment of multiple domains of cognitive function in alert patient
What are the subtypes of dementia?
Alzheimer’s disease
Vascular dementia
Lewy body dementia
Frontotemporal dementia
What is Alzheimer’s disease?
Neuropsychiatric disorder causing progressive cognitive impairment
Leading cause of dementia
What is Vascular dementia?
Cumulative effect of many small strokes
Evidence of arteriopathy
What is Lewy body dementia?
Caused by abnormal clumps of protein (called Lewy bodies) gathering inside brain cells
Detailed visual hallucinations
Later parkinsonism
What is frontotemporal dementia?
Frontal and temporal atrophy with loss of >70% of spindle neurons
What examinations may be done for dementia?
Cognitive function
Neurological
Vascular
What investigations may be done for dementia?
Bloods: FBC, U&E, LFTs, Calcium, Glucose, TFTs, Vitamin B12, Folate levels
CT/MRI
CSF
EEG
Functional Imaging
Genetics
What screening tests are used for cognitive function?
- Mini mental state examination (MMSE)
- Montreal Cognitive Assessment (MOCA)
- Addenbrooke’s Cognitive examination (ACE-II)
What is the non- pharmacological management of dementia?
- Information and support
- Dementia services
- Occupational therapy
- Social work/support/respite/placement
- Voluntary organisations
What is the specific treatment for Alzheimer’s dementia?
Cholinesterase inhibitors
NMDA antagonist
What is the specific treatment for vascular dementia?
Lower vascular risk factors?
What is Parkinsonism?
Clinical syndrome with >2 of:
- Bradykinesia (slowness of movement)
- Rigidity (stiffness)
- Tremor (shakiness)
- Postural instability (falls)
What is Parkinson’s disease caused by?
Progressive degeneration of dopaminergic neurones in the substantia nigra leading to dopamine loss
What are the causes of Parkinson’s?
Idiopathic- Dementia with Lewy bodies
Drug induced- dopamine antagonists
Vascular Parkinsonism- affects lower half of body
What are the features of parkinsonism?
Bradykinesia, tremor, rigidity, postural instability
No other cause
Slowly progressive (>5-10 years)
-Good response to dopamine replacement therapy
What is the early treatment of parkinsons?
Dopaminergic neuron- increase dopaminergic function
Give levodopa (precursor for dopamine)
What is the late treatment of parkinson’s?
Prolong levodopa half life:
- MAO-B inhibitors
- COMT inhibitors
- Slow release levodopa
Add oral dopamine agonist- continuous infusion
Functional neurosurgery
What drugs should never be used in Parkinsons?
Atypical antipsychotics
Have strong anti-dopaminergic action so will worsen disease
What are Parkinsons plus syndromes?
A group of degenerative neurological disorders, which differ from the classical idiopathic Parkinson’s disease:
- Different associated clinical features,
- Poor response to levodopa
- Distinctive pathological characteristics
- Poor prognosis.
What are examples of Parkinson’s plus syndromes?
Progressive supranuclear palsy
Multiple system dystrophy
Cortico-basal degeneration
Lewy body dementia
