Degenerative Diseases

Question 1

what are the two main degenerative CNS diseases?

Answer 1

Dementia

Parkinsonism

Question 2

what are 4 common features of neurodegenerative disease?

Answer 2

1. usually late onset
2. gradual progression
3. neuronal loss
4. structural imaging is often normal

Question 3

what is the definition of dementia ?

Answer 3

Progressive impairment of multiple domains of cognitive function in alert patient leading to loss of functional ability

Question 4

why is dementia costly?

Answer 4

cost of care for patient and care giver
medication
time off work

Question 5

is dementia common?

Answer 5

yes

Question 6

is dementia incidence increasing or decreasing ?

Answer 6

increasing

Question 7

how many patients have dementia in the UK?

Answer 7

> 750,000

Question 8

what is the main risk factor for dementia ?

Answer 8

age

Question 9

what are the three main causes of late onset dementia ?

Answer 9

Alzheimers (55%)
Vascular (20%)
Lewy body (20%)

Question 10

state some treatable causes of neurodegeneration ?

Answer 10

Vitamin B12 deficiency 
Hypothyroidism 
Infective - HIV, Syphilis 
Raised ICP 
- hydrocephalus 
- tumour 
Depression

Question 11

what is the most important thing to make a diagnosis ?

Answer 11

the history from the patient and a witness (family member or GP)

Question 12

what questions should be asked in the history?

Answer 12

symptoms
progression
if risk factors are involved
family history

Question 13

what investigations can be done to help with the diagnosis of neurodengerative disease?

Answer 13

bloods 
- B12, thyroid function 
CT/MRI 
- hydrocephalus 
CSF 
EEG

Question 14

what domains of cognition may be affected ?

Answer 14

• memory
• attention
• language and speech
• visuospatial
• behaviour
• emotion
• executive function
• apraxias (complex task such as dressing themselves)
• agnosias

Question 15

what two screening tests can be done to test cognitive function?

Answer 15

Mini-mental (MMSE)

Montreal (MOCA)

Question 16

if the symptoms have a stepwise progression what cause would it suggest?

Answer 16

vascular

Question 17

if the symptoms had a rapid progression what cause would it suggest?

Answer 17

CJD

Question 18

what is the most common neurodegenerative condition?

Answer 18

Alzheimers

Question 19

What age do people start to get Alzheimers ?

Answer 19

70yrs

Question 20

what signs and symptoms are seen with temporo-parietal dementia ?

Answer 20

early memory disturbance
language and visuospatial problems
personality is spared

Question 21

what signs and symptoms are seen with frontotemporal dementia ?

Answer 21

early change in personality
often changes eating habits
early dysphasia
memory/ visuospatial is relatively spared

Question 22

what are the two categories for symptomatic treatment of neurodegenerative disease?

Answer 22

non-pharmacological

pharmacological

Question 23

what non pharmacological options of treatment are there for dementia?

Answer 23

education and support
occupational therapy
social work
voluntary organisations

Question 24

what pharmacological options of treatment are there for dementia ?

Answer 24

insomnia
behavioural with antipsychotics
anti depression drugs

Question 25

what specific treatment can be used for dementia ?

Answer 25

cholinesterase inhibitors

NMDA antagonist

Question 26

what type of neurotransmitter neurones are lost during Alzheimers ?

Answer 26

ACh neurotransmitter neurones

Question 27

how do the cholinesterases inhibitors work to help with the symptoms of Alzheimers?

Answer 27

they inhibit the re uptake of ACh from the synaptic cleft so more ACh is present in the synapse

Question 28

what four symptoms can someone with parkinsonism have?

Answer 28

Bradykinesia (slowness of movement)

Rigidity (stiffness)

Tremor (shakiness)

Postural instability (unsteadiness / falls)

Question 29

to be diagnosed with parkinsonism how many of the four symptoms do you need to have?

Answer 29

2 or more

Question 30

where abouts in the brain does damage resulting in parkinsonism occur ?

Answer 30

basal ganglia

Question 31

what neurones are lost in parkinsonism ?

Answer 31

mainly neurones which release dopamine

Question 32

what are the two main causes of parkinsonism ?

Answer 32

idiopathic Parkinsons disease 
drug induced (dopamine antagonists)

Question 33

are males or females effected by parkinsons disease more ?

Answer 33

males

1.5M:F

Question 34

name the two most common types of neurodegenerative diseases?

Answer 34

Alzheimers

Parkinson’s

Question 35

at what age does the incidence of parkinson increase a lot ?

Answer 35

65yrs

Question 36

what treatment can be used for parkinsons disease?

Answer 36

dopamine replacement treatment

Question 37

what functional imaging can be used to determine if the symptoms of parkinsonism is drug induced to due to neurodegeneration ?

Answer 37

dopamine transporter SPECT

- shows the neurones between the caudate and putamen

Question 38

what three mechanism of treatment of Parkinsons is there?

Answer 38

1. Levodopa
   - promotes the production of dopamine
2. Dopamine agonist
   - promotes binding of dopamine at receptor of synapse
3. MAO-B inhibitor
   - inhibits the re uptake of dopamine from the synaptic cleft

Question 39

when are drugs suggested for parkinsons?

Answer 39

if the symptoms are very bad and they are struggling with daily tasks

Question 40

what are 3 later complications of the drugs used to treat parkinsons?

Answer 40

motor fluctuations - when the drug wears off
dyskinesias - involuntary movements
psychiatric - hallucinations

Question 41

what are some later complications of parkinsons?

Answer 41

depression 
dementia 
autonomic problems 
- BP, Bladder, Bowel problems 
Speech, swallowing problems 
Balance

Question 42

what can be done to prevent motor fluctuations when the drugs of parkinsons wears off?

Answer 42

prolong levodopa half life
add oral dopamine agonist
continuous infusion