dementia & parkinsons Flashcards
what is dementia
progressive impairment of multiple domains of cognitive function
multiple types
alzheimers is most common type
how is dementia diagnosed
PMH
medication - anti-cholinergic
cognitive tests
if there is any doubt refer to neuro for brain imaging
what can cause dementia
alcohol genetics infection inflammatory VB12 deficiency
what are cognitive features of dementia
dysmnesia (memory problems)
dysphasia
dyspraxia
dysexecutive
what are some cognitive tests for dementia
MMSE - lower score correlates with poorer ability to preform daily activities
MOCA
what are examples of functional impairment in dementia
problems making calls, using computer, driving, taking medications, cleaning, eating/cooking, finances, personal care
what can mimic dementia
tumour hydrocephalus depression chronic subdural bleed delirium
what type of dementia should you be suspicious of if the patient is under 65
alcohol dementia
what is alzheimers disease
type of dementia
cause unknown
degeneration, or loss, of neurons in the brain, particularly in the cortex
what are risk factors for alzheimers
downs syndrome
family history
hypothyroidism
how does alzheimers present
amnesia disorientation personality changes - but personality lasts longer than in other types reduction in self care paranoia delusional aggression increased sexuality visuospatial problems
what are the main features of alzheimers on investigation
amyloid plaques and tau tangles
atrophy
reduction in acetylcholine
what investigations could you do in alzheimers
bloods SPECT CT MRI CSF EEG histology - BAT - beta amyloid plaques, decreased ACH, neurofibrillary tangles
how do you manage alzheimers
acetylcholinesterase inhibitors:
galantamine
donepezil
rivastigmine
memantine for more severe disease
what is vascular dementia
2nd most common type after alzheimers
infarcts of small and medium sized vessels in brain causes damage resulting in dementia symptoms
what can vascular dementia follow (3 things)
stroke
multiple strokes
biswanger disease
what are features of vascular dementia
focal impairments
cerebrovascular disease on PMH
step wise decline
how does vascular dementia present
rapid progression + stepwise decline amnesia disorientation changes in personality reduced self care depression UMN signs seizures
how would you manage vascular dementia
treat DM and hypertension
aspirin
smoking cessation
support
what is dementia with lewy bodies
protein deposits in neurons - alpha synuclein seen on biopsy
associated with parkinsons
how does dementia with lewy bodies present
triad
parkinsons
hallucinations
fluctuating course
early visuospatial and executive dysfunction
how do you manage dementia with LB
avoid anti-psychotic drugs
levodopa if parkinsons
supportive - falls
DATScan to look at dopamine re-uptake
what is huntingtons dementia
complication of huntingtons disease
uncontrollable choreiform movements
how does huntingtons dementia present
anxiety depression irritibility OCD psychosis
how do you manage huntingtons dementia and CJD
no cure
manage symptoms
what is creutzfeldt-jakob disease
form of dementia caused by prions
very rare
causes death
how does CJD present
rapid progression 4-5months amnesia disorientation psychosis depression personality change
what is parkinsons disease
proggressive reduction in dopamine in basal ganglia
causes disorders of movement
lewy bodies can form
what are risk factors for parkinsons
cause unknown genetics male environmental exposure to pesticides etc dopamine depleting drugs
how does parkinsons present
at least 2 of: bradykinesia rigidity tremor - slow and on rest, unilateral , pin rolling postural instability progression is slow anosmia REM sleep disorder autonomic symptoms - incontinence depression hallucinations facial masking stooped posture forward tilt reduced arm swing shuffling gait parkinsons plus - multiple system atrophy, supranuclear palsy/corticobasal degeneration
what investigations can you do for parkinsons
dopamine transporter SPECT
CT
how would you manage parkinsons
levodopa with carbidopa
COMT inhibitors - entacapone
dopamine agonists - bromocriptine
MAO-B inhibitors - selegiline
what is frontotemporal dementia
a type of cortical dementia
picks disease is a subtype
what are features of frontotemporal dementia
onset before 65 insidious onset memory and visuospatial skills are preserved better personality change social conduct problems
what are features of picks disease
personality change
impaired social conduct
disinhibition
increased appetite
what changes to the brain are seen in picks disease
atrophy of frontal and temporal lobes
pick bodies
gliosis
neurofibrillary tangles
