Degenerative Diseases of the Central Nervous System Flashcards
What can be said generally about the aetiology of neurodegenerative diseases?
It is largely unknown
The diseases are usually late in onset and with gradual progression
What is a feature of the imaging of neurodegenerative disease?
It is often normal
Define dementia
A syndrome consisting of progressive impairment of multiple domains of cognitive function in alert patient leading to a loss of acquired skills and interference in occupational and social role
What is the incidence of dementia in the UK?
200 per 100,000
What proportion of patients diagnoses with dementia are living in care homes?
66%
What proportion of late onset dementia (65+ years) is made up by Alzheimer’s?
55%
What are some treatable causes of dementia?
B12 deficiency
Thyroid disease
HIV, syphilis
What are some things that can mimic the effects of dementia?
Hydrocephalus
Tumour
Depression
What are the routine Ix for dementia?
Bloods, CT/MRI
Give two cognitive screening tests
MMSE (mini-mental)
Montreal (MOCA)
What does a stepwise progression of dementia suggest?
Vascular type dementia
What does a rapid progression of dementia suggest?
CJD
Tumour
Infection
What is the mean age of onset in Alzheimer’s disease?
70
What are the characteristics of temporo-parietal dementia caused by Alzheimer’s?
Early memory disturbance
Language and visuospatial problems
Personality initially preserved
What are the characteristics of frontotemporal dementia caused by Alzheimer’s?
Early change in behaviour/personality
Change in eating habits
Early dysphagia
Memory/visuospatial relatively preserved
Outline the non-pharmacological symptomatic treatment for Alzheimer’s
Information and support, dementia services
Occupational therapy
Social work, support, respite placement
Voluntary organisations
What should be treated with a pharmacological strategy in Alzheimer’s?
Insomnia
Behaviour
Depression
Outline the specific treatment for Alzheimer’s disease
Cholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine
No delay in institutionalism, small symptomatic improvement in cognition
Define Parkinsonism
A clinical syndrome with two or more of the following symptoms: Bradykinesia Rigidity Tremor Postural instability
What is the general pathology of Parkinson’s disease?
Basal ganglia affected, predominantly dopamine loss
What is the most common cause of Parkinson’s disease
Idiopathic Alzheimer’s - dementia with Lewy bodies
Drug-induced e.g. dopamine antagonists
What is the clinical diagnosis for Parkinson’s disease?
Bradykineseia + at lest one of tremor, rigidity postural instability
Slowly progressive over 5 to 10 years
What can be the early medical treatment of PD?
Levadopa with carbidopa or similar
What are some drug-induced later complications of PD?
Motor fluctuations as drugs eventually wear off
Dyskinesias - involuntary movements
Psychiatric - hallucinations, impulse control
