Lecture 36 Degenerative Diseases of the CNS Flashcards
Common features of neurodegenerative diseases
- Aetiology largely unknown (mendelian genetic cases rare, often younger onset)
- Usually late onset
- Gradual progression
- Neuronal Loss (specific neuropathology)
- Structural imagine often normal (but there may be atrophy that is not visible)
Define Dementia
• Progressive impairment of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interference in occupational and social role
Name causes of late onset dementia
Alzheimer’s, Vascular, Lewy Body, Others- common causes
Name causes of young onset of dementia
Alzheimer’s, Vascular, Frontotemporal, Alcohol, Huntington’s, HIV, CJD, MS)
Name treatable causes of dementia
- Vitamin deficiency -B12
- Endocrine - thyroid disease
- Infective - HIV, syphilis
Name mimics of dementia
o Hydrocephalus
o Tumour
o Depression: Pseudodementia (apathetic, slow thinking, confused)
How do you diagnose dementia
History
Examination
Investigations
What history would you take for diagnosing dementia
o Type of deficit
o Progression
o Risk Factors
o FH
What type of examination would you carry out to diagnose dementia
o Cognitive function
o Neurological
o Vascular
What investigations would you carry out to investigate dementia
o Routine bloods: B12, Thyroid function o CT/MRI- rule out any causes that mimic dementia o CSF- MS, CJD o EEG o Functional imaging o Genetics (biopsy)
Name the various domains involved in the examination of cognitive function
- Memory, attention, language, visuospatial,
* Behaviour, emotion, executive function
What is apraxia
inability copy certain movements and are unable to, inability to dress- cognitive ability to create a motor plan
What is agnosia
does not recognizes faces, can’t tell its face- unable to link sensory to cognitive processing
What screening tests can be used to examine cognitive function
- Mini-mental (MMSE)- memory
* Montreal (MOCA)- executive function and memory
What is the commonest neurodegenerative condition
Alzheimer’s
What are the risk factors for Alzheimer’s
Genetic Smoking Exercise Diet Alcohol
Name features of temporal-parietal dementia
– Early memory disturbance
– Language and visuospatial problems
– Personality preserved until later
Name the features of Fronts-temporal dementia
- Early change in personality / behavior
- Often change in eating habits
- Early dysphasia
- Memory / visuospatial relatively preserved
Name features of Vascular dementia
Mixed picture
Stepwise decline
Non-pharmacological treatment of Alzheimer’s
– Information & support, dementia services
– Occupational therapy
– Social work / support / respite / placement
– Voluntary organisations
Specific treatment for Alzheimer’s
– Cholinesterase inhibitors (cholinergic deficit)
– NMDA antagonist (memantine)
No treatment for fronto-temporal
Decrease vascular risk factors for vascular dementia
What are the clinical features of Parkinson’s
– Bradykinesia (slowness of movement)
– Rigidity (stiffness)
– Tremor (shakiness)
– Postural instability (unsteadiness / falls)
What is the pathology of the basal ganglia in Parkinson’s
Predominantly dopamine loss
What are the causes of Parkinson’s
Dopamine antagonists Vascular parkinsons Dementia with Lewy bodies Multiple system atrophy Progressive supra nuclear palsy
