Dementia and Parkinson's Flashcards
Classic triad of Parkinsons
Resting tremor
Bradykinesia
Rigidity
Parkinsons pathophysiology
Reduction of dopamine in basal ganglia
How do symptoms present in Parkinsons (not the specific symptoms)
Asymmetrically
One side is normally worse than the other
What is basal ganglia responsible for
Coordinating movements
Where is the substantial nigra and what does it do
Part of the basal ganglia that produce dopamine
Typical demographics of a parkinsons patient
70M
Describe Parkinsonian tremor and how it may change
4-6hz - pill rolling
Tremor is worsened if patient is distracted
For example asking them do a movement in the other hand
How is a benign essential tremor affected at rest
Improves
Parkinson’s worsens at rest but improves with intentional movement
How does a benign tremor change with alcohol
Improves
What type of dementia is associated with Parkinsons
Lewy body
Key drugs for Parkinsons and how do they work
Co-……..-Dopa
Synthetic dopamine with a decarboxylase inhibitor to stop domaine being broken down
Can also use COMT inhibitors, dopamine agonists (pulmonary fibrosis), and monoamine oxidase B inhabitors
Drug of choice for delirium tranquillisation
Haloperidol
Memory loss features in dementia
Short term more effected than long term
5 key types of dementia
AD
D with Lewy bodies
Huntingtons
Picks disease and frontotemporal
Vascular
(Other secondary causes)
Most common form of dementia
AD (50%)
Risk factors for AD
Female sex
FH
Downs syndrome
Head injury
Key pathophysiology of AD
Formation of amyloid plaques
Cortical atrophy
Senile plaques and neurofibrillary tangles
Second most common cause of Dementia
D with Lewy bodies (20%)
What are Lewy bodies
Alpha-synuclein cytoplasmic inclusions
Key feature for Lewy body dementia
Early impairments in attention (rather than just memory in comparison to AD)
Features of Parkinson’s
Visual hallucinations
Type of scan to diagnose Lewy body dementia
SPECT scan
What drugs should be avoided in a patient with Lewy body dementia having visual hallucinations
Anti-psychotics!!
Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer’s
Drug treatment for Lewy body dementia
Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer’s
NICE recommended assesment tool for cognitive impairment and dementia screening
10-CS (cognitive screen)
GPCOG and MMSE (score of less than 24/30)
Risk factors for Picks disease
Age 45-60 years
Female
Scandinavian?
Neuropathology changes since in Picks disease
‘knife blade’ atrophy affecting frontal and temporal lobes
Pick bodies
Clinical features of Picks disease
Frontotemperal dementia
Insidious and progressive dementia with very prominent personality changes
hyperorality (examine objects by mouth), disinhibition and increased appetite
Commonest cause of delirium
Drugs (not infection!)
Key way to differentiate delirium and dementia
Consciousness (impaired in delirium)
Onset time
Course (delirium fluctuates)
1st line class of drug in AD and DLB
Cholinesterase inhibitor (donepezil, rivastigmine galantamine)
What is Picks disease
FT dementia
Which type of dementia is the most rapidly progressing
DLB
Death common within 7 years
visual hallucinations and Parkinson-like symptoms -> dx
DLB
Differentiating DLB with Parkinsons
Parkinsons physical symptoms come first
Dementia under 65 -> dx
FT dementia
CJD
What dementia is associated with MND
FT
Dementia most associated with visual hallucinations
DLB
Can be in late vascular
rapid onset dementia and myoclonus
CJD
