Dementia and Parkinson's

Question 1

What are the causes of dementia which are treatable?

Answer 1

B12 deficieny
Thyroid disease (endocrine)
HIV
Syphilis

Question 2

What conditions can mimic dementia?

Answer 2

Hydrocephalus
Tumour
Depression- pseudodementia

Question 3

Definition of dementia?

Answer 3

Progressive impairment of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interference in occupational and social role

Question 4

Age for early onset?

Answer 4

Below 65

Question 5

Most common type of Dementia?

Answer 5

Alzheimer’s, this develops as Beta-amyloid plaques and neurofibrillary tangles in the brain. This is usually a tempo-parietal dementia, so early signs of memory loss and personality is persevered until later.

Question 6

Signs of fronto-temporal dementia

Answer 6

Early personality change (loss of impulse control, e.g. can become hypersexual, binge eat).
Early dysphasia.
Memory and visospatial are relatively preserved.

Question 7

Defining features of Lewy body dementia?

Answer 7

Parkinsonism and hallucinations

Fluctation in symptoms (get better than worse)

Question 8

Defining features of Vascular dementia?

Answer 8

Stepwise progression

mixed picture of cognitive domains affected

Question 9

Treatment for dementia?

Answer 9

Symptomatic e.g anti-depressants, melatonin for insomnia

Alzheimer’s and Lewy body dementia can be treated with Cholinesterase inhibitors (e.g. Donepezil and galantamine)- as there is a cholinergic deficient in these conditions
NMDA antagonist e.g. memantine

Question 10

What pathology causes Parkinson’s disease?

Answer 10

It is usually dopamine loss in the basal ganglia.

Lewy body formation in the basal ganglia is the commonest degenerative cause.

Question 11

What are the screening tests that can be done for Dementia?

Answer 11

Mini-mental (MMSE)- this mainly focuses on deficents seen in Alzheimer’s.
Montreal (MOCA)-covers visual, visuospatial and executive function much better than MMSE.

Question 12

What are the risk factors for Alzheimer’s?

Answer 12

Smoking
Obesity
Hypertension
Diabetes

Exercise, cognitive reserve and good diet can all decrease the risk.

Question 13

What are the symptoms of Parkinson’s disease and how many need to be present for a diagnosis?

Answer 13

Rigidity (stiffness)
Bradykinesia (slowness of movement)
Tremor (shakiness-usually a resting pill-rolling tremor)
Postural instability-unsteadiness/falls

Bradykinesia and one other symptom have to be present.
No other cause can be found and the condition must be slowly progressive.

They may also have:
loss of smell
REM sleep behaviour disorder (they act out their dreams)
Hallucinations
Urinary incontinence

Question 14

What are the causes of Parkinson’s?

Answer 14

Idiopathic (dementia with Lewy bodies)
Drug-induced (such as anti-psycotics and antiemetics that are dopamine antagonists)
Vascular

Parkinson’s plus syndromes( e.g. multiple system atrophy, progressive supranuclear palsy)

Question 15

Risk factors of Parkinson’s?

Answer 15

Genetic
Pesticides

Smoking and caffeine decrease risk.

Question 16

What are the types of treatment for Parkinson’s and examples?

Answer 16

Levodopa- passes through blood brain barrier and converted to Dopamine 
Dopa decarboxylase inhibitors(prevent levodopa -> dopamine conversion in PNS)- e.g. Carbidopa 
COMT inhibitors (prevent Levodopa breakdown)- e.g. tolcapone
Dopamine agonists - e.g. ropinirole
MAO-B inhibitors (prevent dopamine breakdown) e.g. selegiline.

Question 17

What are some late compilcations of Parkinson’s disease?

Answer 17

Levodopa can wear off and cause motor fluctuations (worsening symptoms before next dose)- this can be treated by slow release levodopa, COMT inhibitors ect
Dyskinesias (involuntary movements caused by levodopa)
Hallucinations
~50% get dementia after 10 years
gait freezing