Neurodegenerative Disorders: Dementias And Movement Disorders Flashcards
What are some examples of neurodegenerative diseases
Parkinson’s and Alzheimer’s disease
What are the two ways by which neurons could be lost
Degeneration (neuronal death from accumulation of degenerative product in or around the neuron) and apoptosis (neuronal death without accumulation of degenerative product)
A native protein thought to assist in neurotransmitter release and vesicle turnover. Lewy bodies are produced from the aggregation of these proteins with other protein complexes
What protein is this
Alpha-synuclein
What is dementia
A clinical syndrome with multiple causes defined as an acquired disorder characterized by a decline in cognition involving at least one cognitive domains (learning and memory, language, executive function, complex attention, perceptual motor and social cognition)
1.The decline must represent a change from a patients prior level of cognitive ability
2.Is insdious onset, persistent and slowly progresses over time.
3.Severe enough to interfere with daily function and independence
What is cognition
•The word cognition comes from the Latin noun cognitio which means examination, learning or knowledge
•It is defined as the mental action or process of acquiring knowledge and understanding through thought, experience and the senses.
•The brain is endlessly perceiving, processing, planning, organizing and remembering.
What are the top five causes of dementia
•Alzheimer’s disease (AD)
•Vascular dementia
•Lewy body disease (LBD)
•Parkinson’s disease (PDD)
•Fronto temporal dementia.
NB: Mixed dementia - having more than one of these causing dementia
Among the top causes, only vascular dementia is not a neurodegenerative disease.
What are some RFs of dementia
Age (>60)
•Genetics (APP, PSEN1, PSEN2, APOE)
•Mild cognitive impairment
•Ischemic or hemorrhagic stroke
•Cardio embolic risk factors ( Diabetes, Hypertension, smoking, vascular disease)
•Low educational attainment, physical inactivity, social isolation
•Alcohol
•Head trauma
•Hearing loss
What are some classifications (based on the primary site of pathology)
Cortical dementia: Frontotemporal dementia and Alzheimers disease
Subcortical dementia: Parkinson’s disease dementia
Cortical-subcortical dementia: Lewy body dementia
What are some clinics features of dementia
Memory loss.
Problems with speaking including difficulty completing sentences or finding the right word to say
Difficulty completing tasks.
Difficulty recognizing items or people.
Showing signs of poor judgment.
May have problems preparing food, performing household chores, paying bills
May repeat questions or stories regularly
Forget appointments
They may get lost in familiar environments
Personality changes, including irritability or agitation, may also occur.
In some cases, people with dementia develop hallucinations
What are the pathological hallmarks of Alzheimer’s disease
The pathological hallmarks of AD are beta-amyloid plaques, neurofibrillary tangles and reactive gliosis
While patients with AD have amyloid plaques (an accumulation of an abnormal protein) identified in certain areas of their brain, it is unclear if these plaques are the cause of the disease or a result of the disease
What are some investigatory scans made in Alzheimer’s disease (AD)
CT and MRI scans
It is associated with pronounced atrophy of the frontal and temporal lobes in the brain.
In addition to forgetfulness and word finding problems, patients may have marked personality changes, impulsivity or poor judgment.
Some patients can develop incoordination or stiffness of their muscles
What kind of dementia is this
Frontotemporal dementia
It is caused by Lewy bodies, which are abnormal clumps of certain proteins, accumulating inside of neurons.
•Forgetfulness and other signs of cognitive decline are the primary features of this condition.
•Patients can also develop prominent hallucinations which seem very real to them.
•Some patients develop symptoms which look like Parkinson’s disease, such as tremor and slowness.
Which kind of dementia is this
Lewy body dementia/Lewy body disease
Refers to patients who have evidence of two (or more) types of dementia.
•Alzheimer’s disease and vascular dementia are the most common causes of mixed dementia.
What kind of dementia is this
Mixed dementia
How do you diagnose
History
They are often brought in by a spouse or an informant.
•Details, timing and progression of complaints
•ASK: agitation, aggression, hallucination, wandering, slow repetitious speech, apathy , mood disturbance
•The functional status (basic activities of daily living)
•Safety (driving, finances and ability to use appliances)
•Past medical history (cardiovascular disease, neurologic disease, head trauma, or concussion)
•Drugs (benzodiazepines, anticholinergics, opioids and antipsychotics
•Family history (family history of dementia and cardio metabolic factors)
•Social history (current living arrangement, support network)
•Review of system ( rule out conditions such as thyroid disease, vitamin B12 deficiency, hypercalcemia, atrial fibrillation, and depression)
