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Year 2 - Nervous > Dementia & Parkinson's > Flashcards

Dementia & Parkinson's Flashcards

1
Q

2 commonest degenerative diseases of the CNS

A

Dementia

Parkinson’s

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2
Q

Define Parkinsonism

A

A clinical syndrome with ≥2 of:

Tremor
Rigidity
Akinesia/ bradykinesia (slowness) - IDEALLY 1 OF THEM SHOULD BE THIS
Postural instability (unsteadiness)

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3
Q

What is the pathology in Parkinson’s disease

A

Dopamine deficiency in the substantial nigra

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4
Q

Which dementias are more late onset (65+) (3)

A

Alzheimer’s disease
Vascular dementia
Lewy body dementia

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5
Q

Causes of young onset dementia (4)

doesn’t necessarily mean they affect young more than old, but just the common causes of dementia in younger people

A 
Alzheimer's disease
Vascular dementia
Frontotemporal  dementia 
Other
-alcohol
-genetics (huntington's)
-MS
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6
Q

Most common cause of dementia

A

Alzheimer’s disease

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7
Q

Mimics/reversible causes of dementia (6)

A 
B12 deficiency 
Thyroid disease
Infection - HIV
Hydrocephalus - normal pressure hydrocephalus
Brain tumour
Depression
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8
Q

Conditions featuring parkinsonism (4)

A

Idiopathic Parkinson’s disease - COMMONEST
Drug induced Parkinsonism
Vascular parkinsonism - affects those with restricted blood to brain
Parkinson-plus syndrome (those that have parkinsonian features but don’t respond to normal treatment)

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9
Q

Parkinsonism is not the same as Idiopathic Parkinson’s disease

A

Term that covers a range of conditions that have similar symptoms to idiopathic Parkinson’s disease (referred to as Parkinson’s)

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10
Q

Name 3 Parkinson-plus syndomes (those that have parkinsonian features but don’t respond to normal treatment)

A

Multiple system atrophy
Progressive supra nuclear palsy
Dementia with lewy bodies

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11
Q

Lewy body dementia in its advanced stages has features that mimic what degenerative disease

A

Idiopathic parkinson’s disease (full name for colloquial “Parkinson’s”)

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12
Q

Most common form of parkinsonism

A

Idiopathic Parkinson’s disease (full name for colloquial “Parkinson’s”)

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13
Q

If parkinsonian patients present with early dementia then the dementia is probably what type

A

Lewy body dementia

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14
Q

Diagnosis steps of dementia

  • history questions (3)
  • cognitive examination (list 6 domains that can be examined + 2 screening tests of mental status)
  • investigations (8) - most are to exclude other causes of dementia
A

History

  • type of cognitive deficit
  • speed of progression
  • risk factors - family history, age, down’s, smoking, hypertension

Cognitive function examination

  • memory
  • attention/concentration
  • language
  • emotion
  • executive functions - handling complex tasks, reasoning,
  • perceptual motor functions, e.g. visuospatial
  • mini mental state examination (MMSE)
  • montreal cognitive assessment (MoCA)

Investigations

  • FBC - rule out anaemia
  • BG
  • U+Es - rule out hypo/hypernatraemia etc
  • TFTs - rule out hyper/hypothyroidism
  • B12 - rule out B12 induced dementia
  • Urinalysis - to rule out illicit drug induced
  • CT - to rule out space occupying lesions, NPH
  • MRI
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15
Q

definitive diagnosis of dementia and Parkinson’s disease

A

Post mortem

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16
Q

Diagnosis of Parkinson’s disease

  • history
  • examination
A

History:
-Clinical diagnosis of:
Bradykinesia
+ ≥1 of tremor, rigidity, postural instability
-Slowly progressive (5-10 years)
-Tremor is usually asymmetric and when resting

Examination

  • all of above
  • slow shuffling gait

NO ADDITIONAL DIAGNOSTIC TEST NEEDED IF EXAMINATION FINDINGS CONSISTENT WITH HISTORY

17
Q

Lab tests and imaging etc only needed to help diagnose Parkinson’s in what circumstances (5)

*NO ADDITIONAL DIAGNOSTIC TEST NEEDED IF EXAMINATION FINDINGS CONSISTENT WITH HISTORY

A

Atypical features:

acute onset, rapidly progressive disease, early cognitive impairment, symmetrical findings, or upper motor neuron signs

18
Q

What can confirm the diagnosis of idiopathic Parkinson’s disease

A

A trial of dopaminergic agent (levodopa)

19
Q

Alzheimer’s dementia also known as

+ pathophysiology

A

Temporo-parietal dementia

Beta amyloid rich senile plaques in grey matter + neurofibrillary tangle formation –> impaired neurone signalling –> neurone apoptosis/death

20
Q

Clinical features of Alzheimer’s dementia (temporo-parietal dementia) (7)

A

EARLY memory loss

Decline of daily activities - executive function decline

Disorientation (confused) - getting lost or misplacing items

Nominal dysphasia - difficulty naming people/things

LATER personality/behavioural change
-e.g. apathy (lack of interest or concern), social disengagement

Mood changes - mood swings from depression to very irritable

21
Q

Risk factors of Alzheimer’s dementia (4)

A

Old age >65
Family history of it
Genetic mutations - APP, presenilin 1/2
Down’s syndrome

22
Q

Clinical features of frontotemporal dementia (a younger onset dementia) (5)

A

EARLY change in personality/social behaviour - impulsive, no empathy

Early dysphasia (loss of language fluency and comprehension)

LATER memory loss

Progressive self-neglect - not caring about personal hygiene, dishevelled appearance

Altered eating habits

23
Q

Is memory loss and personality change an early or later symptom in Alzheimer’s dementia (temporo-parietal dementia) and frontotemporal dementia

A

Memory loss:
early in alzheimer’s
late in frontotemporal

Personality change:
late in alzheimer’s
early in frontotemporal

24
Q

Describe the progression pattern of vascular dementia

A

Stepwise, gradual progression

25
Q

2nd commonest type of dementia in elderly

A

Vascular dementia

26
Q

Causes of vascular dementia (2)

A

Multiple infarction of brain tissue (often due to stroke/TIA)

  • Ischaemia
  • Haemorrhage

Small vessel changes

27
Q

Clinical features of vascular dementia (5)

A

PROMINENT EARLY EXECUTIVE FUNCTION DEFICIT

  • EARLY slowness of thought/slowed processing of information
  • Difficulty planning - EARLY
  • Difficulty solving problems - EARLY

Poor attention/concentration

Apathy - lack of interest or concern

Memory loss LESS prominent

28
Q

Memory loss not so prominent in what type of dementia

A

Vascular

29
Q

What type of drugs are used to treat the abnormal behaviour of dementia but increase mortality

A

Anti-psychotics

30
Q

Specific treatment of Alzheimer’s disease
-for mild/moderate disease (1)
-for severe disease or if above drug is ineffective (1)
+/- other pharmacological treatment for co-existing symptoms (2)
-non-pharmacological treatment (2)

A

Cholinesterase inhibitors
-donepezil, rivastigmine

NMDA (N-methyl D-aspartate antagonist) antagonist
-memantine

Antidepressants
Antipsychotics

Carer support
Environmental modification/enhance safety - sound + motion detectors, changing to electric hob

31
Q

Is there any specific treatment of vascular dementia + if not then how is it managed (4)

A

None

Treat the risk factors that cause vascular dementia, i.e. control atherolosclerotic/cardioembolic disease

  • antiplatelets
  • anticoagulants
  • BP control (anti-hypertensives)
  • statins
32
Q

Is there specific treatment for frontotemporal dementia + if not then what are the management options

A

No

May give benzodiazepines, SSRIs - to control severe impulsive behaviours

33
Q

Treatment of Parkinson’s disease (4 classes of drugs + name example of each)

A

Dopamine replacement - levodopa + carbidopa (needs to be taken together to prevent levodopa being changed into dopamine before it reaches the brain)

Dopamine agonists

  • pramipexole
  • ropinirole

MAO-B inhibitor

  • rasagiline
  • selegiline

COMT inhibitor
-entacapone

34
Q

Why does levodopa have to be combined with carbidopa when taking it

A

Prevents levodopa being metabolised into dopamine before it reaches the brain/outside the CNS (i.e. increases levodopa availability)

Carbidopa is a peripheral decarboxylase inhibitor that prevents peripheral conversion of levodopa into dopamine (which cannot cross the BBB), and therefore increases the availability of levodopa in the CNS

35
Q

Non-drug induced complications of Parkinson’s disease (4)

A

Depression
Dementia
Bladder/bowel incontinence
Dysphagia

36
Q

Side effects of dopaminergic drugs (i.e. dopamine replacement, dopamine agonists) (4)

A

Nausea
Vomiting
Psychosis/ Impulsive behaviour
Dyskinesias

37
Q

Dopamine antagonists are obviously contra-indicated in parkinson’s as you want dopamine agonists instead to improve the dopamine deficiency (= pathology of parkinson’s)

However, dopamine agonists cause nausea/vomiting whereas dopamine antagonists improve this

What is the only dopamine antagonist that can be used in parkinson’s to improve vomiting due to the vomiting centre being outside the BBB

A

DOMPERIDONE

Year 2 - Nervous (39 decks)

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