PD & LBD Flashcards
Zarkali lecture (34 cards)
What is the one year rule for LBD
If cognitive problems (like memory loss and thinking difficulties) develop before or within one year of the onset of PD movement symptoms, the diagnosis is more likely LBD.
If cognitive problems develop more than one year after the onset of PD movement symptoms, the diagnosis is more likely PD.
Purpose of 1 year role
To dintinguish between PD and LBD
What are the 4 issues of the One year rule?
- Depends on who is making the diagnosis
- It’s a continuum
- Cognitive changes in prodromal Parkinson’s
- Ignores underlying pathology
What is the difference in pathology between PD & LBD?
LBD affects more brain regions
Which is more severe
LBD
What 6 features are shared between LBD & PD?
- Progressive dementia
2.Cognitive fluctuations
3.Visual hallucinations
4.Motor parkinsonism(LBD 25-50%)
5.REM sleep diorder - Synucleiopathy: cortical Lewy body depositio
Which is the 2nd most common dementia
LBD
Who is more likely to get PD
older, male, visual dysfunction at diagnosis
Which has a worse prognosis than AD
LBD?
Essential Clinical diagnostic criteria
- Progressive cognitive decline interfering with daily life
- Prominent memory impairment evident with progression
- Attention, executive, visuo-perceptual may occur early
4 Core clincial features LBD
- Fluctuating cognition
- Recurrent visual hallucinations
- REM sleep disorder
- Parkinsonism: tremor / rigidity / parkinsonism
3 indictive biomarkers of LBD?
- Reduced uptake DaT uptake (PET or SPECT).
- Low uptake on Iodine MIBG myocardial scintigraphy
- REM sleep without atonia (paralysis)on polysomnography
4 Supportive imaging biomarkers of LBD?
- Preserved medial temporal lobe
- General low uptake on CT perfusion
- Reduced PET occipital uptake
- Prominent slow on EEG with temporal sharp waves
3 Core clinical diagnosis of PD?
- Diagnosis of Parkinson’s disease
- Dementia develops >1 year after PD diagnosis
- Cognitive impairment in >1 domain and affects daily life
Associated features of PD
- Cognitive profile involves 2 of
- Attention
- Executive
- Visuospatial
- Recall
- Apathy / depression / anxious mood / hallucinations / sleepiness / delusions
Types of hallucinations
Illusions
Pareidolias-pattern in random stuff
Passage- fleeting movement
Cognitive fluctations of PD and LBD and what it suggets
Variation in attention / alertness
* underlying thalamic damage
* Cholinergic deficits
How do REM sleep disorders link to PD/LBD
- Strongly associated
- > 90% with RBD will develop PD or DLB (or MSA) after 10 year follow-up
- And seen in autopsy-conformed DLB
- May reflect distinct subtype: earlier disease onset, more rapid
progression.
6 Autonomic changes
- Orthostatic hypotension
- Carotid sinus hypersensitivity
- Dizziness
- Blackouts
- Falls
- Urinary incontinence
What is the neurophycoligcal profile
1.Visuospatial
2.Executive deficits
Describe pathology of PD/LBD
A-syn inclusions
Lewy bodys and neurites
In the cortical limic and brainstem (following gut brain link)
77% of patients diagnosed with DLB
have..
AD co-pathology
What will a strcutral MRI reveal about LBD
Varying hippocampal loss
Volume loss in parietal and frontal regions
What does FP-CIT SPECT reveal about LBD?
Little activity in basal area
Not that clear cut
worth repeating at one year interval if -ve at first
