Degenerative Diseases of CNS

Question 1

What is the definition of dementia?

Answer 1

A syndrome consisting of progressive impairement of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interference in occupational and social role

Question 2

What is the definition of parkinsonism?

Answer 2

A clinical syndrome with > 2 of the following:

• Bradykinesia (slow movements)
• Rigidity (stiffness)
• Tremor (shakiness)
• Postural instability (unsteadiness/falls)

Question 3

What are the causes of dementia?

Answer 3

65+ y.o:

• Alzheimers (55%)
• Vascular (20%)
• Lewy body (20%)

Question 4

What are the causes of parkinson’s?

Answer 4

1) Idiopathic (dementia with Lewy bodies)
2) Drug-induced (dopamine antagonists)
3) Vascular parkinsonism

Question 5

How is Dementia diagnosed?

Answer 5

1) History from independent witness:

• Type of deficit
• How has it progressed
• What risk factors do they have
• Family History of Dementia

2) Examination:

• Cognitive functioning
• Neurological
• Vascular

3) Investigations:

• Bloods
• CT/MRI
• EEG, CSF

Question 6

How is Parkinsons diagnosed?

Answer 6

Clinical diagnosis:

• Bradykinesia + 1 or more than 1 of tremor, rigidity, postural instability
• Slow progression (5-10 years)
• Asymetric rest tremor
• Good response to dopamine replacement therapy

Question 7

How are Dementia symptoms treated?

Answer 7

Symptomatic Treatment:

1) Non pharmacological:

• Information & support, dementia services
• Occupational therapy
• Social work
• Voluntary organisations

2) Pharmacological:

• Insomnia
• Behaviour
• Depression

Question 8

What are the specific treatments of Dementia?

Answer 8

Alzheimers:

• Cholinesterase inhibitors (donepezil, rivastigmine)
• NMDA antagonist (memantine)

Question 9

What is the treatment of Parkinson’s Disease?

Answer 9

Conservative:

• Patient education
• Gait and mobility rehab

Medical:

• Levodopa (crosses BBB and converted to dopamine)
• Carbidopa (given with levodopa)
• Selegiline (MOA-B inhibitor)
• Ropinirole (dopamine agonist)

Question 10

What are the features of temporo-parietal dementia and frontotemporal demention in relation to Alzheimers disease?

Answer 10

Tempero-Parietal dementia:

• Early memory disturbance
• Language and visuospatial problems
• Personality preserved

Fronto-temporal dementia:

• Early change in personality/behaviour
• Change in eating habits
• Early dysphasia
• Memory usually preserved