Degenerative diseases of the CNS and movement disorders Flashcards
Disorders covered?
Dementia
Parkinson’s
Motor neurone disease
what is dementia?
Progressive impairment of multiple domains of cognitive function in alert pt leading to loss of acquired skills and interefernce in occupational and social role
common causes of dementia?
Alzheimer’s (55%)
Vascular (20%)
Levy body (20%) - parkinson field
Others (5%)
how to diagnose dementia?
History (get an independent witness, family)
(Type of deficit, progression, risk factors, FH)
Examination
Cognitive function, neurological, vascular
Investigations
Routine - bloods, brain imaging
examination of cognitive function?
Memory
Attention
Language
Visuospatial
Behaviour, emotion, executive function
Apraxia’s, agnosias (has motor but can’t process sensory)
what’s a good screening test for cognitive function?
Draw a close and out the numbers on etc
How common is Alzheimer’s disease?
Commonest neurodegerative condition
what type of dementia is Alzheimer’s disease?
Temporo-parietal dementia
- early memenory disturbance
- language and visuospatial problems - dysphasia
- personality preserved until later
pathology of Alzheimer’s disease?
Amyloid plaques - normal proteins becomes abnormal, tau tangles (protein becoming tangled n the cell)
Some therapies aimed at this pathology
symptomatic treatment for Alzheimer’s?
Non-pharmological
- information and support, dementia services
- occupational therapy
- social work/support/respite/placement
- voluntary organisations
Pharmacologically
- insomnia
- behaviour (care with antipsychotics)
- depression (often missed in pt with demtia problems)
specialist tx for Alzheimer’s?
Can also be used to treat t with Lewy body demnitia
- cholinesterase inhibitrs (cholinergic deficit) - small improvement in cognition
- NMDA antagonists (memantine)
- anti-amyloid antibodies (lecanemab)
-> give IV every 2 weeks (not a good system)
examples of cholinesterase inhibitors?
Donepezil, rivastigmine, galantamine
dental issues associated with Alzheimer’s?
Poor comprehension (consent/capacity)
Easily confused (strange environments / pain)
Poor speech
Excessive saliva due to excess acetylene choline
Neglect of dental care
Management of Alzheimer’s in a dental setting?
Time and explanation
Best if with friends / family
Calm approach
Show as well as say
Plan with patient early in dementia
Think ahead
- prevention and long-term management
Specialist / hospital services e.g. sedation
second most common dementia related disease?
Parkinson’s
features of Parkinson’s?
Slowly progressive (5-10 years)
Bradykinesia - loses amplitude, function slows. Slow, low (amplitude), flow
Supported by asymmetrical onset
Rest tremor
Postural instability
Narrow gate and swinging arm
medical tx for Parkinson’s?
Dopamine replacement therapy
- give pt levodopa, package with enzyme blocker to prevent breakdown of levodopa
Package with: carbidopa or benserazide
Basal ganglia dopamineric system is hit my Parkinson’s
Makes the remaining nerve cells produce more dopamine
later complications of Parkinson’s?
Drug-induced
- motor fluctuations - levodopa wears off
- dyskinesias - involuntary movements (levodopa)
- psychiatric - hallucinations, impulse control
Non-drug induced esp non-motor
- dementia
- autonomic - BP, bladder, bowel
- speech/ swallow
- balance/falls/freezing
Late tx for Parkinson’s?
Medication:
- after real medications
- continuous infusion (apomorphine, levodopa)
Functional neurosurgery - deep brain stimulation
Allied health professionals
dental issues associated with Parkinson’s?
Movement problems
Details
Swallowing
Drooling
Dry mouth (rarer)
Dentures
Deep brain stimulators: ab
Dental mamagent of a pt with Parkinson’s?
Give time to respond
Struggle with multitasking
Minimise distractions and clutter
Advice - local PDS society / medic/ nurse
Specialist hospital rx/sedation
Speech therapy and language therapy
Saliva management
Good denture care
does motor neurone disease have cognitive associations?
Yes, 10 % do
prognosis of MND?
Median survival 2-3 years form diagnosis
50% die within 14 months of diagnosis
MND signs in the mouth?
Tongue vesiculations
MND Tx?
Supportive
Riluzole (glutamate antagonist)
Anticipatory/ palliative
Dental:
- dysarthria/weakness, saliva, swallow
Other movement disorders?
Essential - shake head yes
Dystonic tremor - shake head no
Cervical dystonia
- can touch finger to nose
- non-degenerative
managemebt of essential tremor?
Beta blockers
Primidone
Alcohol
Benzodiazepines
Deep brain stimulation
Tx for dystonia?
Anticholinergics
Botulinum toxin
Benzodiazepines
Deep brain stimulations
