Degenerative diseases of the NS Flashcards
what are common characteristics of the NS degenerative diseases
- Late onset
- Gradual progression
- Neuronal loss
- Imaging useful
- aetiology unknown
What is dementia
- patient alert
- Progressive impairment of multiple domains of cognitive function
- Loss of skills in social and occupational roles
What are the late onset causes of dementia?
In over 65s:
- Alzheimers
- Lewy body
- Vascular
What is Lewy body demential associated with
Clumps of proteins which aggregate in neurones
What are the young onset causes of dementia?
Under 65s Alzheimers -Vascular -Fronto-temporal -Others Alcohol Genetic e.g. Huntingtons Infection e.g. HIV, CJD Inflammation e.g. MS
What are the treatable causes of dementia?
- B12 deficiency
- Infections e.g. HIV
- Endocrine e.g. associated with thyroid disease
Differential diagnosis for dementia
- Depression
- Hydrocephalus
- Tumours- particularly frontal tumours
Why is dementia such a big issue?
- It impacts 2/3rds of families
- It is very expensive for both the NHS and families
- Common and increasing
- NO cure
History of some one with dementia
FROM AN INDEPENDENT WITNESS Type of deficit - behavioural changes Progression Family history Risk factors
Examination of a patient with dementia
Cognitive :
- Test memory, attention, behaviour, language, emotion, agnosias, apraxias
- Screening tests e.g. Mini mental test, Montreal
Neurological
Vascular
Investigations of a patient with dementia
- CT/MRI
- Bloods
- CSF
- Genetics
- EEG
- Functional imaging
- Brain biopsy
clues to help differentiate between different types of dementia
-Type of deficit
-Progression of disease
-other signs :
Myoclonus
Parkinsonism
Abnormal movement
Progression of alzheimers
TEMPO-PARIETAL DEMENTIA :
Affects memory
Visual spatial and language disturbances
Personality affected later on
Progression of fronto-temporal dementia
Early changes to personality
Dysphagia
Changes in eating habits
Memory and visuospatial problems present later on
Characters of. vascular dementia
- Mixed problems
- Stepwise decline
How to treat dementia
- Non-pharmalogical
- Pharmalogical
Non -pharmalogical
- OT/social carers
- Voluntary work
- Information services
Pharmalogical
- Problems sleeping
- Behaviour e.g. eating
- Depression
How to treat dementia
-specific
Alzheimers/lewy body dementia
-Cholinesterase inhibitors e.g. DONEPEZIL
-NMDA (N-methyl, D-aspartatate) antagonist/ MEMANTINE:
In Alzheimers too much glutamate is produced
Glutamate is an NT which is taken into cells via NDMA
How to diagnose parkinsonism
-Bradykinesia + 1 of rigidity, tremor, postural instability
-Tremor is:
At rest
Asymmetric
Responds to dopamine treatment
-No other causes
-Slow progression: 5-10 years
What does imaging in parkinsonism reveal
Reduced dopamine transporter at the basal ganglia
Early treatment of parkinsonism
- Dopamine agonists
- Levadopa
- COMT inhibitor: breaks down levodopa into product which is not dopamine
- MAO-B inhibitor: prevents dopamine in pre-synaptic terminal from being broken down
Examples of dopamine agonists
Ropinirole
Rotigotine
Pramipexole
Example of COMT inhibitor
entecapone
Later onset symptoms of Parkinson’s
Drug induced:
- Motor fluctuations as levodopa wears off
- Dyskinesia
- Psychiatric problems e.g. hallcinations
Non-drug induced
- Depression
- Dementia
- Autonomic problems e.g. BP, bladder
- Speech and swallowing problems
- Balance
Later treatment for Parkinson’s
-Prolong half-life of levodopa: Slow release levodopa COMT inhibitors MAO-B inhibitor Add oral levodopa
- Functional neurosurgery for brain stimulation
- Add in help from other health care professionals
causes of Parkinson’s
- Idiopathic
- Drug induced: dopamine antagonists
- Vascular Parkinsonism - affects lower half of limbs
- Parkinson’s plus syndrome: multi-system atrophy, progressive supra nuclear palsy, corticospinal degeneration
