Degenerative Diseases of the Central Nervous System Flashcards

1
Q

What can be said generally about the aetiology of neurodegenerative diseases?

A

It is largely unknown

The diseases are usually late in onset and with gradual progression

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2
Q

What is a feature of the imaging of neurodegenerative disease?

A

It is often normal

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3
Q

Define dementia

A

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

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4
Q

What is the incidence of dementia in the UK?

A

200 per 100,000

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5
Q

What proportion of patients diagnoses with dementia are living in care homes?

A

66%

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6
Q

What proportion of late onset dementia (65+ years) is made up by Alzheimer’s?

A

55%

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7
Q

What are some treatable causes of dementia?

A

B12 deficiency
Thyroid disease
HIV, syphilis

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8
Q

What are some things that can mimic the effects of dementia?

A

Hydrocephalus
Tumour
Depression

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9
Q

What are the routine Ix for dementia?

A

Bloods, CT/MRI

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10
Q

Give two cognitive screening tests

A

MMSE (mini-mental)

Montreal (MOCA)

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11
Q

What does a stepwise progression of dementia suggest?

A

Vascular type dementia

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12
Q

What does a rapid progression of dementia suggest?

A

CJD
Tumour
Infection

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13
Q

What is the mean age of onset in Alzheimer’s disease?

A

70

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14
Q

What are the characteristics of temporo-parietal dementia caused by Alzheimer’s?

A

Early memory disturbance
Language and visuospatial problems
Personality initially preserved

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15
Q

What are the characteristics of frontotemporal dementia caused by Alzheimer’s?

A

Early change in behaviour/personality
Change in eating habits
Early dysphagia
Memory/visuospatial relatively preserved

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16
Q

Outline the non-pharmacological symptomatic treatment for Alzheimer’s

A

Information and support, dementia services
Occupational therapy
Social work, support, respite placement
Voluntary organisations

17
Q

What should be treated with a pharmacological strategy in Alzheimer’s?

A

Insomnia
Behaviour
Depression

18
Q

Outline the specific treatment for Alzheimer’s disease

A

Cholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine
No delay in institutionalism, small symptomatic improvement in cognition

19
Q

Define Parkinsonism

A
A clinical syndrome with two or more of the following symptoms:
Bradykinesia
Rigidity
Tremor
Postural instability
20
Q

What is the general pathology of Parkinson’s disease?

A

Basal ganglia affected, predominantly dopamine loss

21
Q

What is the most common cause of Parkinson’s disease

A

Idiopathic Alzheimer’s - dementia with Lewy bodies

Drug-induced e.g. dopamine antagonists

22
Q

What is the clinical diagnosis for Parkinson’s disease?

A

Bradykineseia + at lest one of tremor, rigidity postural instability
Slowly progressive over 5 to 10 years

23
Q

What can be the early medical treatment of PD?

A

Levadopa with carbidopa or similar

24
Q

What are some drug-induced later complications of PD?

A

Motor fluctuations as drugs eventually wear off
Dyskinesias - involuntary movements
Psychiatric - hallucinations, impulse control

25
Q

What are some non drug-induced later complications of PD?

A

Depression
Dementia
Autonomic dysfunction e.g. BP, bladder, bowel
Sensory and sleep

26
Q

What drugs can be used to prolong the half-life of dementia?

A

MAO-B inhibitors
COMT inhibitors
Slow release levadopa