Degenerative Diseases of CNS Flashcards
what is dementia?
progressive impairment of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interface in occupational and social role
what are the 3 most common causes of late onset dementia?
> alzheimers
vascular
lewy body
what are the 3 most common causes of dementia in young onset?
> alzheimers
vascular
fronototemporal
name a genetic cause of young onset dementia
huntingtons
what infections can cause dementia?
> HIV
> CJD
what inflammatory conditions cause dementia?
MS
what are some treatable conditions of dementia?
> B12 deficiency
thyroid disease
HIV
syphilis
what conditions can mimic dementia?
> hydrocephalus
tumour
depression
how is dementia diagnosed?
> history from independent witness
examination of cognitive function, neurological and vascular
blood, CT/MRI investigations
what investigations would you carry out for dementia?
> bloods > CT/MRI (> CSF >EEG > functional > genetics)
name 2 cognitive function screening tests
> mini-mental (MMSE)
> montreal (MOCA)
what clues are there to diagnoses of dementia?
> type of cognitive deficit > speed of progression > abnormal movements (huntingtons) > parkinsons (lewy body) > myoclonus (CJD)
how does CJD dementia progress?
rapidly
how does vascular dementia progress?
stepwise
what is the commonest neurodegenerative condition?
alzheimer’s disease
describe the dementia in alzheimer’s
> temporo-parietal disturbance
early memory disturbance
language and visuospatial problems
personality preserved until later
describe fronto-temporal dementia
> early change in personality
change in eating habits
early dysphasia
memory/visuospatial relatively preserved
how does vascular dementia decline?
stepwise
what non-pharmacological symptomatic treatment is there for dementia?
> information and support
OT
social support
voluntary organisations
what symptoms can you treat pharmacologically for dementia?
> insomnia
behaviour
depression
what specific treatment is there in alzheimers?
> cholinesterase inhibitors (donepezil)
> NMDA antagonist
name some clinical signs that are present in parkinsonism
> bradykinesia (slowness of movement)
rigidity (stiffness)
tremor (shakiness)
postural instability (unsteadiness/falls)
in parkinsonism what neurotransmitter is lost?
dopamine
name some causes of parkinsonism
> idiopathic dementia with lewy bodies > drug induced > vascular > multiple system atrophy > progressive supranuclear palsy
describe the clinical diagnosis of parkinsonism
> bradykinesia with tremor, rigidity or postural instability
slow progression
supported by asymmetric rest tremor and good response to dopamine replacement treatment
what imaging is used to view the basal ganglia in parkinsonism?
dopamine transporter SPECT
name 4 early medication treatment in parkinsons
> levodopa
COMT inhibitor
MAO-B inhibitor
dopamine agonists
what drug stops levodopa being converted to 3OMD?
COMT inhibitor
what does levodopa become in the synaptic terminal?
L-DOPA
what is the action of MAO-B inhibitor?
it converts dopamine to DOPAC
what are some drug induced later complications of parkinsons?
> motor fluctuations as levodopa wears off
dyskinesias
psychiatric (hallucinations, impulse control)
name some non-drug induced later complications of parkinsons
> depression > dementia > autonomic > speech > balance
what drugs prolong the levodopa half life?
> MAO-B inhibitors
COMT inhibitors
slow release levodopa
what is the late treatment for parkinsons?
> drugs-oral dopamine agonist, continuous infusion
functional neurosurgery
allied health professionals
