Problem 10: Scoping Reasons for Emotional Change Flashcards
Explain whether anger could be a symptom of PD
Although not outlined as a symptom that can be treated in NICE guidelines there are multiple side effects and states of parkinsons that could contribute to the anger.
This anger will not be found on any of the list of “non-motor” symptoms because it is not a direct outgrowth of the neurological change. It is a reaction to having a difficult, chronic disease.
Depression, hallucinations and delusions are common symptoms of progressive PD.
Critically summarise the pathophysiology and the key charateristics and symptoms of dementia
Alzheimers disease: most common type (atrophy and loss of neurons in the brain associated with cognitive function and memory such as the cerebral cortex) Characterised by beta amyloid plaques and neurofibrillary tangles.
Vascular dementia: blood supply to the brain is interrupted by a blocked or diseased vascular system. Diagnosed with MRI or CT scan to confirm lesions.
Dementia with Lewy Body (DLB): clumps of alpha-synuclein in dopaminergic neurons of substantia nigra. These clumps are the Lewy bodies. Loss of cholinergic neurons and dopaminergic neurons are responsible for fluctuating cognition and movement respectively. Recurrent visual hallucinations key symptoms
Parkinson’s Disease Dementia (PDD): pathology the same as DLB. Dementia preceding onset of movement disorder by one year = DLB. Dementia occurring within movement disorder = PDD. One third of PD patients develop PDD.
Fronto-temporal dementias: mutation in tau protein disrupts normal nerve cell processes leading to death of cells. Frontal: reasoning judgement and apathy, temporal: speech language and memory.
Analyse whether or not an association between dementia and PD exist
One third of patients with PD develop dementia.
There are 2 types of dementia related to Parkinson’s. These are:
Parkinson’s dementia
Dementia with Lewy bodies
When the motor symptoms of Parkinson’s are present for at least a year before experiencing dementia, this is known as Parkinson’s dementia.
Dementia with Lewy bodies is diagnosed when the symptoms of dementia appear before or at the same time as Parkinson’s symptoms.
The symptoms present in dementia can vary from person to person and according to the type of dementia a person might have.
The spread of Lewy bodies into the cortex - the outer parts of the brain that are involved in thinking - are likely to be the primary reason for dementia in people with Parkinson’s.
Lewy bodies are sticky clumps of proteins found inside the nerve cells that are lost in Parkinson’s. As they spread into other brain areas, Lewy bodies prevent nerve cells communicating properly, cause loss of the neurotransmitter acetylcholine, and ultimately cause nerve cell death.
It is thought that Parkinson’s disease dementia results from microscopic deposits known as Lewy bodies, located in nerve cells in the brain stem (the lower part of the brain just above the spinal cord). As Parkinson’s disease progresses, Lewy bodies spread beyond the brain stem into other parts of the brain, causing dementia.
Lewy bodies are also seen in dementia with Lewy bodies (DLB). Parkinson’s disease dementia appears very similar to dementia with Lewy bodies. The main difference is that problems with movement occur before cognitive symptoms in dementia associated with Parkinson’s disease. In dementia with Lewy bodies, cognitive symptoms occur before, or at the same time as, problems with movement .
Summarise the steps in reaching a diagnosis of dementia
Depending on patient presentation; arrange admission for people with suspected dementia if they are severely disturbed and admission is needed to ensure health and safety of person.
Refer to psychiatry or neurology services (with urgency depending on professional judgement) is person is <65, have focal neurological signs, rapid cognitive decline, genetic cause likely, learning difficulties.
All other people are referred to a memory assessment service (such as memory clinic or community mental health team) for further specialist care.
MRI and CT are involved in specialist investigations, exclude differential diagnosis and identify dementia subtype. CSF examination may be used to exclude inflammatory, infective or malignant causes. Brain biopsy in highly selected people whose dementia is thought to be due to a potentially reversible condition (cerebral vasculitis).
The diagnosis of dementia is reached by the exclusion of other conditions, since there are currently no specific diagnostic investigations available. Although some risk factors are fixed, others may be modifiable. Since these modifiable risks are also implicated in other conditions such as cardiovascular disease and stroke, pharmacists can encourage their reduction as part of healthy lifestyle advice.
Compare and contrast the various types of dementia, and comment on any symptoms which are common in all forms
Alzheimers disease: most common type (atrophy and loss of neurons in the brain associated with cognitive function and memory such as the cerebral cortex) Characterised by beta amyloid plaques and neurofibrillary tangles.
Vascular dementia: blood supply to the brain is interrupted by a blocked or diseased vascular system. Diagnosed with MRI or CT scan to confirm lesions.
Dementia with Lewy Body (DLB): clumps of alpha-synuclein in dopaminergic neurons of substantia nigra. These clumps are the Lewy bodies. Loss of cholinergic neurons and dopaminergic neurons are responsible for fluctuating cognition and movement respectively. Recurrent visual hallucinations key symptoms
Parkinson’s Disease Dementia (PDD): pathology the same as DLB. Dementia preceding onset of movement disorder by one year = DLB. Dementia occurring within movement disorder = PDD. One third of PD patients develop PDD.
Fronto-temporal dementias: mutation in tau protein disrupts normal nerve cell processes leading to death of cells. Frontal: reasoning judgement and apathy, temporal: speech language and memory.
Common early onset symptoms: memory loss
difficulty concentrating
finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping
struggling to follow a conversation or find the right word
being confused about time and place
mood changes
