Degenerative diseases of the CNS Flashcards
what are common features of neurodegenerative diseases
cause unknown late onset gradual progression neuronal loss structural imaging often normal
what is dementia
a syndrome of:
- progressive impairment of multiple domains of cognitive function in alert patient
- leading to loss of acquired skills
- interference in occupational and social role
what is the prevalence of dementia in the UK
1,500 per 100,000
what is the link between dementia and age
incidence is age dependent
- risk increases with age
what is the difference between young and later onset dementia
young onset <65 years
late onset >65 years
some different causes
what are the main causes of young onset dementia
- alzheimers - 33%
- vascular - 15%
- frontotemporal - 15%
- other - 33%
- toxic (alcohol)
- genetic (huntingtons)
- infection (HIV, CJD- Creutzfeldt-Jakob disease)
- inflammatory (MS)
what are the main causes of late onset dementia
- alzheimers - 55%
- vascular - 20%
- lewy body - 20%
- others - 5%
what are some treatable causes of dementia
Vitamin deficiency - B12
Endocrine - thyroid disease
Infective - HIV, syphilis
what are some mimics of dementia
Hydrocephalus (NPH)
Tumour
Depression: “pseudodementia”
how can dementia be diagnosed
history - independent witness
- type of deficit, progression, risk factors, FH
examination - cognitive function, neurological, vascualr
investigations - bloods, CT/MRI
CSF, EEG, functional imaging, gentics (biopsy)
what domains make up cognitive function
Memory
attention
language
visuospatial
Behaviour
emotion
executive function
Apraxias
agnosias
how can you examine cognitive function
mini-mental (MMSE)
montreal (MOCA)
neurophysiological assessment
when can a definitive dementia diagnosis be made
post mortem
what clues can help determine the cause of the dementia
the type of cognitive deficit
speed of progression
other neurological signs
what types of dementia can be diagnosed by speed of progression
CJD - rapid progression
vascular - stepwise progression
what types of dementia can be diagnosed by other neurological signs
Huntington’s - abnormal movement
Lewy body - parkinsonism
CJD - myoclonus
what is alzheimers
the commonest neurodegenerative condition
mean onset 70yrs
involves tempro-parietal dementia
what is the presentation of alzheimers temporo-parietal dementia
Early memory disturbance
Language and visuospatial problems
Personality preserved until later
what is the presentation of frontotemporal dementia
Early change in personality / behaviour
Often change in eating habits
Early dysphasia
Memory / visuospatial relatively preserved
what is the presentation of vascular dementia
mixed picture
stepwise decline
what is the type of treatment for dementia
supportive treatment
non-pharmacological
pharmacological
give examples of non-pharmacological management
Information & support, dementia services
Occupational therapy
Social work / support / respite / placement
Voluntary organisations
give examples of symptoms that could use pharmacological treatment
Insomnia
Behaviour (care with antipsychotics)
Depression
what is the specific treatment for alzheimers (+/-lewy body) dementia
cholinesterase inhibitors
- donepezil, galantamine
NMDA antagonist
- memantine
