Degenerative Diseases Flashcards
what are the two main degenerative CNS diseases?
Dementia
Parkinsonism
what are 4 common features of neurodegenerative disease?
- usually late onset
- gradual progression
- neuronal loss
- structural imaging is often normal
what is the definition of dementia ?
Progressive impairment of multiple domains of cognitive function in alert patient leading to loss of functional ability
why is dementia costly?
cost of care for patient and care giver
medication
time off work
is dementia common?
yes
is dementia incidence increasing or decreasing ?
increasing
how many patients have dementia in the UK?
> 750,000
what is the main risk factor for dementia ?
age
what are the three main causes of late onset dementia ?
Alzheimers (55%)
Vascular (20%)
Lewy body (20%)
state some treatable causes of neurodegeneration ?
Vitamin B12 deficiency Hypothyroidism Infective - HIV, Syphilis Raised ICP - hydrocephalus - tumour Depression
what is the most important thing to make a diagnosis ?
the history from the patient and a witness (family member or GP)
what questions should be asked in the history?
symptoms
progression
if risk factors are involved
family history
what investigations can be done to help with the diagnosis of neurodengerative disease?
bloods - B12, thyroid function CT/MRI - hydrocephalus CSF EEG
what domains of cognition may be affected ?
- memory
- attention
- language and speech
- visuospatial
- behaviour
- emotion
- executive function
- apraxias (complex task such as dressing themselves)
- agnosias
what two screening tests can be done to test cognitive function?
Mini-mental (MMSE)
Montreal (MOCA)
if the symptoms have a stepwise progression what cause would it suggest?
vascular
if the symptoms had a rapid progression what cause would it suggest?
CJD
what is the most common neurodegenerative condition?
Alzheimers
What age do people start to get Alzheimers ?
70yrs
what signs and symptoms are seen with temporo-parietal dementia ?
early memory disturbance
language and visuospatial problems
personality is spared
what signs and symptoms are seen with frontotemporal dementia ?
early change in personality
often changes eating habits
early dysphasia
memory/ visuospatial is relatively spared
what are the two categories for symptomatic treatment of neurodegenerative disease?
non-pharmacological
pharmacological
what non pharmacological options of treatment are there for dementia?
education and support
occupational therapy
social work
voluntary organisations
what pharmacological options of treatment are there for dementia ?
insomnia
behavioural with antipsychotics
anti depression drugs
what specific treatment can be used for dementia ?
cholinesterase inhibitors
NMDA antagonist
what type of neurotransmitter neurones are lost during Alzheimers ?
ACh neurotransmitter neurones
how do the cholinesterases inhibitors work to help with the symptoms of Alzheimers?
they inhibit the re uptake of ACh from the synaptic cleft so more ACh is present in the synapse
what four symptoms can someone with parkinsonism have?
Bradykinesia (slowness of movement)
Rigidity (stiffness)
Tremor (shakiness)
Postural instability (unsteadiness / falls)
to be diagnosed with parkinsonism how many of the four symptoms do you need to have?
2 or more
where abouts in the brain does damage resulting in parkinsonism occur ?
basal ganglia
what neurones are lost in parkinsonism ?
mainly neurones which release dopamine
what are the two main causes of parkinsonism ?
idiopathic Parkinsons disease drug induced (dopamine antagonists)
are males or females effected by parkinsons disease more ?
males
1.5M:F
name the two most common types of neurodegenerative diseases?
Alzheimers
Parkinson’s
at what age does the incidence of parkinson increase a lot ?
65yrs
what treatment can be used for parkinsons disease?
dopamine replacement treatment
what functional imaging can be used to determine if the symptoms of parkinsonism is drug induced to due to neurodegeneration ?
dopamine transporter SPECT
- shows the neurones between the caudate and putamen
what three mechanism of treatment of Parkinsons is there?
- Levodopa
- promotes the production of dopamine - Dopamine agonist
- promotes binding of dopamine at receptor of synapse - MAO-B inhibitor
- inhibits the re uptake of dopamine from the synaptic cleft
when are drugs suggested for parkinsons?
if the symptoms are very bad and they are struggling with daily tasks
what are 3 later complications of the drugs used to treat parkinsons?
motor fluctuations - when the drug wears off
dyskinesias - involuntary movements
psychiatric - hallucinations
what are some later complications of parkinsons?
depression dementia autonomic problems - BP, Bladder, Bowel problems Speech, swallowing problems Balance
what can be done to prevent motor fluctuations when the drugs of parkinsons wears off?
prolong levodopa half life
add oral dopamine agonist
continuous infusion
