-
what 4 things does the frontal lobe control?
- contralateral motor control
- speech on dominant side
- executive function
- personality and behaviour
-
what 3 main things does the temporal lobe control?
-
what does occipital lobe control?
vision
-
what does non-dominant parietal lobe control?
- sensory cortex contralateral
- complex VISUAL skills
-
what does the dominant parietal lobe control?
- Sensory cortex - sensory (contralateral)
- CALCULATION
- Limb praxis
- Literacy – reading, writing and spelling
-
what is executive function?
ability to monitor, anticipate, inhibit and therefore adapt mental processing
-
what is dementia?
- acquired
- progressive
- chronic impairment
- of cognitive function
-
what features need to be present for dementia to be diagnosed?
- impairment must be SEVERE ENOUGH to cause impairment in OCCUPATIONAL or SOCIAL functioning
- must be decline from a PREVIOUSLY HIGHER LEVEL of functioning
-
how can you distinguish dementia from delirium?
- onset: chronic v acute
- cause: brain v systemic
- alertness: preserved v altered
- sleep: sun-downing v reversed
- motor: wandering v restless
- hallucinations: maybe in DLB v often
- language: word finding difficulty v incoherent
- memory: consistent level v variable
- course: insidiuous deterioration v fluctuation
- duration: irreversible v days-weeks
- effect of Rx: supportive v often curative
-
what are causes of delirium…pneumonic
- I WATCH DEATH
- infection
- withdrawal
- acute metabolic
- trauma
- CNS
- hypoxia
- deficiency
- endocrine
- avute vascular
- toxins or drugs
- hospital
-
what is the main pathology in dementia?
- abnormal PROTEIN deposited in brain
- loss of brain cells
- altered chemicals in brain
-
what % of over 80's have dementia?
20%
-
what are the 4 main causes of dementia?
- Alzheimers disease
- Vascular cognitive impairment
- Dementia with Lewy Bodies
- Fronto-temporal lobe degenerations
-
what are metabolic causes of dementia?
B12 or folate deficiency, hypothyroid, wilsons, alcohol
-
what are the inflamm/infecitve causes of dementia?
HIV, MS, vasculitis, autoimmune
-
what are degenerative causes of dementia?
huntingdon's, parkinson's plus, prion disease
-
what are structural causes of dementia?
- chronic subdural haematoma
- brain tumours
-
what is parkinson's disease characterised by?
degneration of dopaminergic neurones in substantial nigra that project to striatum
-
what are the cardinal features of PD?
- resting tremor - pill rolling
- cogwheel rigidity
- bradykinesia
- shuffling, festinant gait, no arm swing, hard to start and stop
-
what is the differential diagnosis of parkinsons? clue vodka
- vascular events elsewhere: (stroke, MI) = vascular parkinsons
- orthostatic hypotension and atonic bladder: multi system atrophy (Shy-Drager)
- dementia + vertical gaze paralysis: supranuclear palsy
- kayer-fleisher ring: wilsons disease
- apraxic gait: communicating hydrocephalus
-
what are the features and causes of drug induced parkinsons?
- more likely to be symmetrical
- any drug that blocks action of dopamine
- neuroleptics (rx schizo): clozapine, risperidone
- meds for N&V: metocloperamide, prochlorperazine
- CCB
-
what is tardive dyskinesia a side effect of?
neuroleptic drugs
-
what are the principles of treatment in PD?
- restore DA activity
- reduce cholinergic activity
-
what is the first line treatment for LATER PD? and what do you give it with?
- Levo dopa: precursor for DA synthesis, crosses BBB
- combo with benserazide/carbidopa: peripheral DOPA-decarboxylase inhibitor (so cant turn Ldopa into dopamine in periphery)
-
What is the treatment for EARLY PD?
- dopamine agonist
- delay L-DOPA for as long as posse
-
what are the disadvantages of L-dopa?
- honeymoon period for 5-6 years: early phase of treatment, DA neurones still present and L-dopa can be stored in nerve terminals so it make a physiological concentration
- WITHOUT FLUCUTATION
- chronic use of L-dopa: motor complications - on and off as nerve endings lost
- Dyskinesia
- SE: psychiatric hallucinations, ortho hypotension, nausea
-
give an example of a dopamine agonist and its MOA and use and an advantage
- apomorphine, cabergoline, bromocriptine
- MOA: direct action on DA receptors, mimic endog DA
- adv: long duration of action esp. cabergoline so less fluctuation in symptom control
- early PD: L-DOPA sparing
- later disease: reduce motor fluctuations as an adjunct to L-DOPA
-
what is the side effect of DA agonist?
- nausea: but treated by peripheral DA antag domperidone
- post hypotension
- hallucination
- daytime somnolence
- constipation
-
what must apomorphine be given with and why?
- domperidone
- apomorphine is very emetogenic
-
what are the 2 categories of drugs that inhibit DA metabolism?
- MAO-B inhibitor: selegiline
- COMT inhibitor: tolcapone, entacapone
-
which is the rationale for using anti-cholinergics in PD? give some e.g. and SE
- rationale: depletion of DA leads to over activity of ACh
- use: improve tremor, stiffness, sialorrhoea, urinary urgency
- eg benzhexol, procyclidine
- SE: dry mouth, blurred vision, urinary retention, constipation, confusion in elderly
-
what is dementia?
- chronic confusion
- progressive, irreversible
- memory, thought, mood changes
- dependence on state and carer
-
what are the 4 common causes of dementia?
- Alzheimer's
- Vacsular (multi-infarct)
- Lewy body dementia
- Fronto-temporal dementia
- CJD
-
what are the 3 pathological features in Alzheimer's?
- beta amyloid plaques: due to accum of B amyloid peptide, a degradation product of amyloid precursor protein - resulting in progressive neuronal damage
- neurofibrillary tangles
- loss of ACh
- what is the treatment of Alzheimer's?
- cholinesterase inhibitors: donezepil, rivastigmine, galantamine
- NMDA antagonist: memantine (not NICE approved)
-
what are the RF for vascular dementia?
atherosclerosis
-
what are the features of vascular dementia?
- impaired exécutive fonction (choc cake)
- apraxia
- emotional lability
- pseudo bulbar palsy (UMNL to corticobulbar path)
- urinary dysfunction
- but preservation of personality
-
what does MRI show in vascular dementia?
diffuse white matter disease
-
what does MRI show in alzheimer's?
atrophy, typically in medial temporal lobes
-
what are the features of fronto-temporal dementia?
- loss of social awareness
- initiation, planning
-
what are the MRI signs of fronto-temporal dementia?
frontal atrophy
-
in vCJD dementia what are the MRI signs?
high signal in posterior thalami
-
in sCJD what are the EEG signs?
periodic spike and wave
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