Dementia & Parkinson's Flashcards
(37 cards)
2 commonest degenerative diseases of the CNS
Dementia
Parkinson’s
Define Parkinsonism
A clinical syndrome with ≥2 of:
Tremor
Rigidity
Akinesia/ bradykinesia (slowness) - IDEALLY 1 OF THEM SHOULD BE THIS
Postural instability (unsteadiness)
What is the pathology in Parkinson’s disease
Dopamine deficiency in the substantial nigra
Which dementias are more late onset (65+) (3)
Alzheimer’s disease
Vascular dementia
Lewy body dementia
Causes of young onset dementia (4)
doesn’t necessarily mean they affect young more than old, but just the common causes of dementia in younger people
Alzheimer's disease Vascular dementia Frontotemporal dementia Other -alcohol -genetics (huntington's) -MS
Most common cause of dementia
Alzheimer’s disease
Mimics/reversible causes of dementia (6)
B12 deficiency Thyroid disease Infection - HIV Hydrocephalus - normal pressure hydrocephalus Brain tumour Depression
Conditions featuring parkinsonism (4)
Idiopathic Parkinson’s disease - COMMONEST
Drug induced Parkinsonism
Vascular parkinsonism - affects those with restricted blood to brain
Parkinson-plus syndrome (those that have parkinsonian features but don’t respond to normal treatment)
Parkinsonism is not the same as Idiopathic Parkinson’s disease
Term that covers a range of conditions that have similar symptoms to idiopathic Parkinson’s disease (referred to as Parkinson’s)
Name 3 Parkinson-plus syndomes (those that have parkinsonian features but don’t respond to normal treatment)
Multiple system atrophy
Progressive supra nuclear palsy
Dementia with lewy bodies
Lewy body dementia in its advanced stages has features that mimic what degenerative disease
Idiopathic parkinson’s disease (full name for colloquial “Parkinson’s”)
Most common form of parkinsonism
Idiopathic Parkinson’s disease (full name for colloquial “Parkinson’s”)
If parkinsonian patients present with early dementia then the dementia is probably what type
Lewy body dementia
Diagnosis steps of dementia
- history questions (3)
- cognitive examination (list 6 domains that can be examined + 2 screening tests of mental status)
- investigations (8) - most are to exclude other causes of dementia
History
- type of cognitive deficit
- speed of progression
- risk factors - family history, age, down’s, smoking, hypertension
Cognitive function examination
- memory
- attention/concentration
- language
- emotion
- executive functions - handling complex tasks, reasoning,
- perceptual motor functions, e.g. visuospatial
- mini mental state examination (MMSE)
- montreal cognitive assessment (MoCA)
Investigations
- FBC - rule out anaemia
- BG
- U+Es - rule out hypo/hypernatraemia etc
- TFTs - rule out hyper/hypothyroidism
- B12 - rule out B12 induced dementia
- Urinalysis - to rule out illicit drug induced
- CT - to rule out space occupying lesions, NPH
- MRI
definitive diagnosis of dementia and Parkinson’s disease
Post mortem
Diagnosis of Parkinson’s disease
- history
- examination
History:
-Clinical diagnosis of:
Bradykinesia
+ ≥1 of tremor, rigidity, postural instability
-Slowly progressive (5-10 years)
-Tremor is usually asymmetric and when resting
Examination
- all of above
- slow shuffling gait
NO ADDITIONAL DIAGNOSTIC TEST NEEDED IF EXAMINATION FINDINGS CONSISTENT WITH HISTORY
Lab tests and imaging etc only needed to help diagnose Parkinson’s in what circumstances (5)
*NO ADDITIONAL DIAGNOSTIC TEST NEEDED IF EXAMINATION FINDINGS CONSISTENT WITH HISTORY
Atypical features:
acute onset, rapidly progressive disease, early cognitive impairment, symmetrical findings, or upper motor neuron signs
What can confirm the diagnosis of idiopathic Parkinson’s disease
A trial of dopaminergic agent (levodopa)
Alzheimer’s dementia also known as
+ pathophysiology
Temporo-parietal dementia
Beta amyloid rich senile plaques in grey matter + neurofibrillary tangle formation –> impaired neurone signalling –> neurone apoptosis/death
Clinical features of Alzheimer’s dementia (temporo-parietal dementia) (7)
EARLY memory loss
Decline of daily activities - executive function decline
Disorientation (confused) - getting lost or misplacing items
Nominal dysphasia - difficulty naming people/things
LATER personality/behavioural change
-e.g. apathy (lack of interest or concern), social disengagement
Mood changes - mood swings from depression to very irritable
Risk factors of Alzheimer’s dementia (4)
Old age >65
Family history of it
Genetic mutations - APP, presenilin 1/2
Down’s syndrome
Clinical features of frontotemporal dementia (a younger onset dementia) (5)
EARLY change in personality/social behaviour - impulsive, no empathy
Early dysphasia (loss of language fluency and comprehension)
LATER memory loss
Progressive self-neglect - not caring about personal hygiene, dishevelled appearance
Altered eating habits
Is memory loss and personality change an early or later symptom in Alzheimer’s dementia (temporo-parietal dementia) and frontotemporal dementia
Memory loss:
early in alzheimer’s
late in frontotemporal
Personality change:
late in alzheimer’s
early in frontotemporal
Describe the progression pattern of vascular dementia
Stepwise, gradual progression
