Degenerative Diseases Flashcards
What is dementia?
Progressive impairment of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interference in occupational and social role
What type of diagnosis is dementia?
Clinical diagnosis
What does the diagnosis for dementia consist of?
History and examination
How is dementia commonly seen in older people?
Memory generally worsens
Becoming more forgetful and start doing odd things
Who does dementia commonly affect?
Disease of the elderly
As age increases how does dementia risk change?
Dementia risk increases
What are the causes of late onset dementia?
Alzheimer’s
Vascular dementia
Lewy body
What are the causes young onset dementia?
Alzheimer’s
Vascular
Frontotemporal
Other - alcohol, genetics (huntington’s), infection (HIV), inflammatory (MS)
How is dementia diagnosed?
History
Examination
Investigations
What investigations should be done for dementia?
Routine bloods CT/MRI CSF EEG Genetics
Can just a patient history give you a diagnosis for dementia?
No
You need an independent witness history
What should be examined for suspected dementia?
Memory attention span Language Behavioural Emotion Executive function Apraxias Agnosias Neuropsychological assessment
What is the speed of progression in CJD?
Rapid
What is the speed of progression in vascular dementia?
Stepwise progression
What can added sign of abnormal movements suggest?
Huntington’s
Which type of dementia is suggested with Parkinsonism?
Lewy body
What is the commonest neurodegenerative condition?
Alzheimer’s disease
What are the signs of temporo-parietal dementia?
Early memory disturbance
Language and visuospatial problems
Personality preserves until later
What are the signs of frontotemporal dementia?
Early change in personality and behaviour
Often change in eating habits
Early dysphagia
Memory/visuospatial relatively reserved
What is the non-pharmalogical Rx for dementia?
Information and support Dementia services OT Social work Respite Voluntary organisations
What is the specific treatment for frontotemporal dementia?
None available
What is the specific Rx for alzheimers +/- lewy body dementia?
Cholinisterase inhibitors Donepezil Rivastigmine Galantamine NMDA antagonist
What is parkinsonism?
A clinical syndrome with 2 of: Ð Bradykinesia (slowness of movement) Ð Rigidity (stiffness) Ð Tremor (shakiness) Ð Postural instability (unsteadiness / falls)
Where is the pathology in parkinsonism?
Basal ganglia
What is lost in the pathology of parkinsons disease?
Dopanergic neurons
What can cause parkinsonism?
Idiopathic
Drug induced (dopamine antagnosits)
Lewy body dementia
Is parkinson’s more common in M or F?
M
What is the clinical diagnosis for parkinson’s?
2 of 3
Bradykinesia
Tremor
Rigidity
What type of tremor does parkinson’s have?
Resting
Pill rolling
What is the response of parkinson’s to dopamine replacement therapy?
Good response
What is the diagnosis for parkinson’s supported by?
Supported by asymmetric rest tremor, good response to dopamine replacement treatment
Does parkinson’s have a fast progression?
No it is slowly progressive (5-10 yrs)
What are later drug induced complications of parkinson’s?
Motor fluctuations - levodopa wears off
Dyskinesias - involuntary movements (levodopa)
Psychiatric - hallucinations, impulse control
Treatment for Parkinsons?
Levodopa
Dopamine agonist
COMT inhibitors
MAO-B inhibitors
How do MAO-B inhibitors work?
Prevent the breakdown of dopamine to the brain
How do COMT inhibitors work?
Block an enzyme that breaks down levodopa
What is bradykinesia?
Slow motor movement
What is the effect of alcohol on parkinson’s tremor?
No effect
What are bradykinesia signs of parkinson’s?
Shuffling gait
Slow to initiate movements
Lack of arm swing
Unable to turn around quickly
What are hypertonia signs of parkinsons?
Rigidity
Cogwheel
What are extra signs in parkinson’s?
Constipation
Postural instability
Soft voice
Low mood
Where is the pathology in Parkinson’s?
Substantia nigra
Basal ganglia
What investigations are done for parkinson’s?
None
It is a clinical diagnosis
