Dementia & PD.txt

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  1. what 4 things does the frontal lobe control?
    • contralateral motor control
    • speech on dominant side
    • executive function
    • personality and behaviour
  2. what 3 main things does the temporal lobe control?
    • hearing
    • learning
    • memory
  3. what does occipital lobe control?
  4. what does non-dominant parietal lobe control?
    • sensory cortex contralateral
    • complex VISUAL skills
  5. what does the dominant parietal lobe control?
    • Sensory cortex - sensory (contralateral)
    • Limb praxis
    • Literacy – reading, writing and spelling
  6. what is executive function?
    ability to monitor, anticipate, inhibit and therefore adapt mental processing
  7. what is dementia?
    • acquired
    • progressive
    • chronic impairment
    • of cognitive function
  8. 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
  9. 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
  10. what are causes of delirium…pneumonic
    • infection
    • withdrawal
    • acute metabolic
    • trauma
    • CNS
    • hypoxia
    • deficiency
    • endocrine
    • avute vascular
    • toxins or drugs
    • hospital
  11. what is the main pathology in dementia?
    • abnormal PROTEIN deposited in brain
    • loss of brain cells
    • altered chemicals in brain
  12. what % of over 80's have dementia?
  13. what are the 4 main causes of dementia?
    • Alzheimers disease
    • Vascular cognitive impairment
    • Dementia with Lewy Bodies
    • Fronto-temporal lobe degenerations
  14. what are metabolic causes of dementia?
    B12 or folate deficiency, hypothyroid, wilsons, alcohol
  15. what are the inflamm/infecitve causes of dementia?
    HIV, MS, vasculitis, autoimmune
  16. what are degenerative causes of dementia?
    huntingdon's, parkinson's plus, prion disease
  17. what are structural causes of dementia?
    • chronic subdural haematoma
    • brain tumours
  18. what is parkinson's disease characterised by?
    degneration of dopaminergic neurones in substantial nigra that project to striatum
  19. 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
  20. 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
  21. 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
  22. what is tardive dyskinesia a side effect of?
    neuroleptic drugs
  23. what are the principles of treatment in PD?
    • restore DA activity
    • reduce cholinergic activity
  24. 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)
  25. What is the treatment for EARLY PD?
    • dopamine agonist
    • delay L-DOPA for as long as posse
  26. 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
    • chronic use of L-dopa: motor complications - on and off as nerve endings lost
    • Dyskinesia
    • SE: psychiatric hallucinations, ortho hypotension, nausea
  27. 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
  28. what is the side effect of DA agonist?
    • nausea: but treated by peripheral DA antag domperidone
    • post hypotension
    • hallucination
    • daytime somnolence
    • constipation
  29. what must apomorphine be given with and why?
    • domperidone
    • apomorphine is very emetogenic
  30. what are the 2 categories of drugs that inhibit DA metabolism?
    • MAO-B inhibitor: selegiline
    • COMT inhibitor: tolcapone, entacapone
  31. 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
  32. what is dementia?
    • chronic confusion
    • progressive, irreversible
    • memory, thought, mood changes
    • dependence on state and carer
  33. what are the 4 common causes of dementia?
    • Alzheimer's
    • Vacsular (multi-infarct)
    • Lewy body dementia
    • Fronto-temporal dementia
    • CJD
  34. 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)
  35. what are the RF for vascular dementia?
  36. 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
  37. what does MRI show in vascular dementia?
    diffuse white matter disease
  38. what does MRI show in alzheimer's?
    atrophy, typically in medial temporal lobes
  39. what are the features of fronto-temporal dementia?
    • loss of social awareness
    • initiation, planning
  40. what are the MRI signs of fronto-temporal dementia?
    frontal atrophy
  41. in vCJD dementia what are the MRI signs?
    high signal in posterior thalami
  42. in sCJD what are the EEG signs?
    periodic spike and wave
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Dementia & PD.txt
2011-10-08 12:53:59

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