NCD LB VD- 15E Flashcards
What is the spectrum of the Lewy Body Disorders
- NCD with Lewy Bodies
- NCD due to Parkinson’s Disease
- Lewy Body variant of Alz Dz (40% of AD pts have LB’s)
What is the pathophysiology of fluctuating vital signs in Lewy Body Disease
-Lewy Bodies in the Brainstem
The core diagnostic features of LBD
- fluctuating cognition
- recurrent detailed visual hallucinations
- Parkinson motor symptoms AFTER cognitive decline
The suggestive diagnostic features of LBD
- REM behavior disorder present (acting out of dreams)
- Severe neuroleptic sensitivity
The essential diagnostic difference between NCD due to LB and NCD due to Parkinson’s Disease
- in NCD due to PD: motor symptoms present for at least 1 year before cognitive symptoms reach level of a major NCD
- otherwise, the cross section of symptoms are similar as is the pathophysiology (Lewy Bodies)
Treatments for LB and PD
- Rivastigmine FDA approved for dementia of Parkinson’s
- Donepezil is prescribed BUT NOT FDA APPROVED
- carbidopa/levodopa not helpful due to worsening associated psychosis
Treatment of psychosis in LB and PD
- start with cholinesterase inhibitors
- then, Pimavanserin (Nuplazid): FDA approved for hallucinations and delusions associated with Parkinson’s disease
- low dose clozapine or the realistic alternative low dose quetiapine
Treatment cautions in Lewy Body Disease
- anti-Parkinson’s meds worsen psychosis
- anti-psychotics worsen parkinsonian symptoms
- anticholinergics worsen cognitive symptoms
Distinguishing diagnostic features for Major Vascular NCD
- onset temporally to cerebrovascular events
- prominent decline in complex attention and frontal-executive function
- focal neurological signs/neuroimaging evidence of CVD
How does history of vascular disease increase risk of NCD vascular disease?
- history of stroke increases risk of vascular NCD by 9 times
- 25% of stroke survivors develop vascular NCD
- history of myocardial infarction
- atherosclerosis
Types of subcortical small vessel disease
- subcortical leukoencephalopathy: Binswanger’s Dz (80% have HTN, widespread, microscopic deep white matter damage)
- lacunar lesions
- CADASIL (autosomal dominant genetic mutation)
Psychomotor symptoms of subcortical vascular disease
- slowness and clumsiness
- gait disturbances and falls
- dysarthria
- urinary incontenence
Dysexecutive symptoms of subcortical vascular disease
- inattention
- inappropriate behavior
Psychiatric symptoms of subcortical vascular disease
- emotional incontence
- apathy, abulia (lack of motivation/initiative)
What is CADASIL?
-Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy
