degenerative diseases of the CNS Flashcards
what are some common feature of neurodegenerative disease?
usually late onset
gradual progression
neuronal loss
structural imaging often normal
what is dementia defined as?
syndrome consisting of progressive impairment of multiple domains of cognitive function i alert patient leading to loss of acquired skills and interference in occupational and social role
what are the most common causes of late onset dementia?(65+ yrs)
alzheimers (55%)
vascular (20%)
lewy body(20%)
others(others)
what are the most common causes of young onset dementia? (<65 yrs)
alzheimers (33%)
vascular (15%)
frontotemporal (15%)
other (33%) (toxic, genetic, infection, inflammatory)
what conditions can “mimic” dementia?
hydrocephalu
tumour
depression
what are some treatable causes of dementia?
vitamin b12 deficiency
thyroid disease
HIV, syphilis
what examinations would you perform to help diagnose dementia?
cognitive function
neurological
vascular
what investigations are appropriate to help diagnose dementia?
bloods
CT/MRI
CSF
EEG
what are the 2 screening tests used to assess cognitive function?
mini mental (MMSE) montreal (MOCA)
what type of dementia would a stepwise progression indicate?
vascular
what would a rapid progression of dementia indicate?
creutzfeld jacob disease
what are some other neurological signs that could help show the cause of dementia?
abnormal movements (huntingtons)
parkinsonism (lewy body)
myoclonus (CJD)
what type of dementia is associated with alzheimers disease?
temporo-parietal dementia
what are some features of temporo parietal dementia?
early memory disturbance
language and visuospatial problems
personality preserved until later
what are some features of frontotemporal dementia?
early change in personality/behaviour
often change in eating habits
early dysphasia
memory/visuospatial relatively preserved
what pharmacological treatments are used to treat alzheimers?
cholinesterase inhibitors NMDA antagonist (memantine)
what are some examples of cholinesterase inhibitors?
donepezil
rivastigmine
galantamine
what features must a patient present with 2 or more of to be classed as having “parkinsonism”?
bradykinesia
rigidity
tremor
postural instability
what is the pathology of parkinsonism?
loss of dopamine in the basal ganglia
what causes parkinsonism?
idiopathic parkinsons disease
drug induced
vascular parkinsonism
parkinson plus syndromes
what are some examples of parkinsons plus syndromes?
multiple system atrophy
progressive supranuclear palsy/corticobasal degeneration
how is parkinsons disease diagnosed?
bradykinesia + 1 or more of: tremor, rigidity or postural intability
no other cause/atypical features
slowly progressive
what does parkinsons disease have a good response to?
dopamine replacement treatment
what imaging modality is useful for diagnosing/staging parkinsons disease?
dopamine transporter SPECT
what are some examples of dopamine agonists?
ropinirole
pramipexole
rotigotine
what is a drug used to convert tyrosine to dopamine?
levodopa
what are some drug induced complications of parkinsons disease?
motor fluctuations - levodopa wears off
dyskinesias - involuntary movements
hallucinations
what are some non drug induced complications of parkinsons?
depression dementia autonomic speech, swallow balance
what drugs can prolong levodopas half life?
MAO-B inhibitors
COMT inhibitors
slow release levodopa
