Degenerative diseases of the CNS Flashcards
What is dementia?
a syndrome consisting of progressive impairment of multiple domains of cortical function in alert patients leading to loss of acquired skills and interference with occupation and social role
what are the main causes of late onset dementia?
alzheimers
lewy body parkinsons
vascular (mini strokes)
what are the causes on early onset dementia?
alzheimers (genetic) vascular frontotemporal toxic (alcohol) genetic (huntington's) infection (HIV, CJD) inflammatory (MS)
what are the treatable causes of dementia?
vitamin B12
hypothyroidism
HIV
syphillis
what can mimic the presentation of dementia?
hydrocephalus
tumour
depression (pseudo dementia)
what do you have to find out when taking a history form a patient and their family when assessing if they have dementia?
type of deficits progression pattern of progression risk factors family history
what are the sub types of dementia?
temporoparietal (alzheimerS)
frontotemporal
vascular
what investigations would you carry out if someone was suspected of having dementia?
bloods CT/MRI CSF (LP) EEG functional imaging genetics
what screening tests can be carried out to examine a patients cognitive function?
mini mental (MMSE) montreal (MOCA)
what are the main clues for identifying dementia and distinguishing it from other syndromes?
spread of progression - if rapid = CJD - if stepwise = vascular abnormal movements = huntington's parkinsonism signs = lewy body
what is agnosia?
no cortical association
can feel what is inside their pocket but cannot make the association as to what it is
what are the main characteristic of alzheeimers dementia?
early memory disturbance
personality preserved until later
language problems
visuospatial problems
what are the main characteristics of front-temporal dementia?
early personality/behaviour disturbance
change in eating habits
early dysphagia
memory / visuospatial spared until late
what are the characteristics of vascular dementia?
mixed picture depending on where the vascular hit is
stepwise decline
what are the treatments for alzheimer’s dementia?
cholinesterase inhibitors e.g. donepezil
NMDA antagonist e.g. memantine
why do most patients with alzheimers present with memory loss and what type of amnesia is this termed as?
because the hippocampus is usually damaged first which is required for searching for memories - therefore they often present with anterograde amnesia
they can remember past memories which are held deep within the brain but can’t remember what they did this morning
what is the criteria for diagnosing parkinson’s?
a clinical syndrome of >2 of; bradykinesia tremor rigidity postural instability
where is the pathology of parkinson’s within th brain?
basal ganglia
what is the pathology of parkinson’s?
dopaminergic neurone loss in the basal ganglia (dopamine loss)
what are the causes of parkinsonism?
lewy body
drug induced e.g. dopaminergic antagonists
vascular parkinsonism
what are the early medical treatments of parkinson’s?
dopamine agonists
levodopa
what are the late medical treatments you can give to patients who have progressive late stage parkinson’s?
prolong levodopa half life with MAO-B inhibitor or COMT inhibitor add oral dopamine agonist functional neurosurgery (brain stem stimulation)
what is the average progression of parkinson’s?
> 5-10 yrs
what is the gait like of someone with parkinson’s?
narrow stance
loss of arm swing
slowness to start
shuffling
what imaging could you use for diagnosing / assessing parkinson’s?
dopamine transporter SPECT
what are the consequences of long term / too high dose of levodopa?
can cause chorea - Levodopa induced dyskinesia
neurological jerky involuntary movements affecting shoulder, face and hips
what are treatable causes of dementia?
HIV
hypothyroidism
syphillis
vitamin B12
