Degenerative diseases of the central nervous system Flashcards
Define dementia
A syndrome consisting of progressive impairment of multiple domains of cognitive function in an alert patient leading to loss of acquired skills and interference in occupational and social role
What is the age cut off between early and late onset dementia?
65
4 causes of late onset dementia
alzheimers
Lewy bodies
vascular
other
4 causes of early onset dementia
Alzheimers
frontotemporal
vascular
other
The “other” causes of dementia
infective eg HIV, CJD
inflammatory eg MS
Toxic eg alcohol
genetic eg huntingtons
List some treatable causes or mimics of dementia
infective eg HIV, syphilis Endocrine eg thyroid disease Vitamin deficiency eg B12 hydrocephalus tumour depression
What is important in a history taking with suspected dementia?
rate of progression, onset, defecit type, risk factors, FH
Examination of dementia
vascular, neurological, cognitive function
Investigations of suspected dementia
routine eg bloods, CT/MRI
others eg CSF, EEG, biopsy, functional imaging and genetics
List some domains of cognitive function to examine
memory, attention, agnosias, apraxias, visuospatial, behavioural, executive function
Screening tests for dementia
MMSE, montreal MOCA
Clues of progression of dementia - rapid? stepwise?
rapid - CJD
stepwise - vascular
Other neurological signs clues with dementia - abnormal movements? parkinsonism? myoclonus?
huntingtons
lewy bodies
CJD
Mean age onset of parkinsonism
70
Does tempero-parietal or fronto-temporal dementia show an early change in personality/behaviour?
fronto-temporal
Non pharmacological symptomatic treatment of dementia
support and information
dementia services
OT, social work, respite, placement
voluntary organisations
Pharmacological treatment of symptoms of dementia
insomnia
depression
behaviour
Specific treatment for alzheimers with or without lewy body dementia
cholinesterase inhibitors
NMDA antagonist
Define parkinsonism
A clinical syndrome consisting of 2 or more of bradykinesia, tremor, rigidity and postural instability
What chemical is lost in parkinson’s and why?
dopamine
basal ganglia
List some causes of parkinsons
idiopathic - dementia with lewy bodies
drug induced eg dopamine antagonists
vascular
progressive supranuclear palsy
Are men or women more likely to get parkinsons?
men - 1.5 times
Prognosis of parkinsons?
60-90% disabled or dead at 10 years
2 things to support a parkinsons diagnosis
asymmetry of tremor
good response to treatment
Functional imaging of parkinsons
dopamine transporter SPECT
List some treatments of parkinsons
dopamine agonist
MAO-B inhibitor
COMT inhibitor
Drug induced complications with parkinsons
motor fluctuations
dyskinesias
psychiatric
Non drug induced complications of parkinsons
depression dementia autonomic eg BP, bladder and bowel speech, swallow balance
Late treatments of Parkinson’s (and aim)
prolong levodopa half life slow release levodopa COMP inhibitor MOA-B inhibitor oral dopamine agonist functional neurosurgery allied health professionals
