Glossary of degenerative dz
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- what is the m/c cause of dementia?
- Alzheimer's disease (senile dementia of Alzheimer type)
- what are the si/sx of alzheimer's dz?
- 1. dementia
- what may be found in Down's sx pts at younger ages (30-40)?
- Alzheimer's dz
- how do you dx Alzheimer's dz?
- 1. clinical
2. definitive diagnosis only possible at autopsy
- what is the tx for Alzheimer's dz?
- 1. anticholinesterase inhibitor can slow dementia
2. antidepressants for psychosis
3. antipsychotics for psychosis
- what is the px for Alzheimer's dz?
- inevitable decline in function usually over approx. 10 yr
- dementia and delirium can both be defined as:
- both cause:
1. global decline in cognition
2. memory, personality, motor, and sensory deficits
- what are the characteristics of dementia?
- 1. constant, progressive course
2. usually not reversible
3. constant problem, no daily pattern
4. consciousness is normal
5. no hallucinations
6. tremors not present
- what are the characteristics of delirium?
- 1. sudden onset, saxing and saning daily
2. almost always reversible
3. usually worse at night (sun-downing)
4. consciousness is altered (obtunded state)
5. often classically visual hallucinations
6. tremors ofen present (asterixis, e.g.)
- what are the causes of demnetia?
- 1. alzheimer's
3. Pick's dz
5. brain infxn/tumor
6. malnutrition (thiamine/B12 def)
- what are the causes of delirium?
- 1. systemic infxn/neoplasm
2. drugs (esp. narcotics and benzodiazepines)
3. stroke, heart dz
6. electrolyte imbalance
- what is the tx for delirium?
- 1. tx underlying cause
2. control sx c/ haloperidol instead of sedatives--pts are often given benzodiazepines or sedatives for agitation, but these drugs often exacerbate the deliriumb/c they disorient pts even more
- what should you NOT give to tx pts with delirium?
- No sedatives--pts are often given benzodiazepines or sedatives for agitation, but these drugs often exacerbate the delirium b/c they disorient pts even more!!
- what are si/sx of multi-infarct dementia?
- 1. acutre stepwise decrease in neurologic fxn
2. multiple focal defictis on exam
4. old infarcts by CT or MRI
- how do you dx and tx multi-infarct dementia?
- 1. dx by clinical and radiographic exam
2. tx=prevent future infarcts by decreasing cardiovascular risks
- how do you characterize Pick's dz?
- 1. clinically resembles Alzheimer's
2. more common in women
3. onset at younger age (50s)
4. frontotemporal dementia
- how do you dx Pick's dz?
- 1. MRI--shows symmetric frontal or temporal atrophy
2. confirm by autopsy
3. Tx/Px as per Alzheimer's
- what are si/sx of Parkinson's dz?
- 1. syndrome of tremor
2. cog-wheel rigidity
4. classic shuffling gait
5. masklike facies
6. dementia from loss of dopaminergic neurons in substantia nigra
- what is the pathophys of Parkinson's dz?
- *loss of dopaminergic neurons in the substantia nigra
*typically progresses over yrs despite tx
- what are ddx of Parkinson's dz?
- 1. severe depression (bradykinesia and flat affect)
2. intoxication (e.g. manganese, synthetic heroin)
3. phenothiazine side effects
4. rare neurodegenerative dz
- what are tx for Parkinsons's dz?
- 1. sinemet (levodopa=carbidopa)--best for bradykinesia
2. anticholinergics (benztropine/trihexyphenidyl) for tremor
3. amantadine--increases dopamine release, effective for mild dz
4. surgical pallidotomy for refractory cases
- which Parkinson's med is best for bradykinesia?
- sinement (levodopa=carbidopa)
- what are the si/sx of Huntingont's chorea?
- 1. progressive choreiform movements of all limbs
2. ataxic gait
5. pts in usually in 30s-50s
- what is the pathophys of Huntingon's chorea?
- 1. autosomal CAG triplet repeat expansion in HD gene
2. atrophy of striatum (esp. caudate nucleus)
3. neuronal loss and gliosis
- what is the dx, tx, and px of Huntington's chorea?
- dx=MRI--will see atrophy of caudate nucleus (striatum) and pos. fam hx
- what are the si/sx of ALS (amyotrophic lateral sclerosis)--motor neuron dz?
- 1. Upper and lower motor neuron dz
2. m. weakness c/ fasciculations (anterior motor neurons)
3. progressing to denervation atrophy
6. difficulty speaking/swallowing
- what is the dx, tx, and px of ALS?
- dx=clinical hx, physical findings
tx/px= supportive, death inevitable, ususally from respiratory failure
- what is the dx of cerebral palsy?
- 1. group of conditions that affect control of movement and posture
2. in approx 70% of cases, CP results from events occurring before birth that can disrupt nml development of the brain
- what are si/sx of CP?
- 1. range from mild to severe
2. condition does not worsen as the child gets older
- what is spastic cerebral palsy?
- 1. m/c form of CP
2. pt's muscles are sitiff, making movement difficult
- what is athetoid or dyskinetic cerebral palsy?
- 1. approx. 10-20% of CP
2. can affect the entire body
3. characterized by fluctuations in m. tone
4. a/c uncontrolled movements
- what is ataxic cerebral palsy?
- 1. approx. 5-10% of CP
2. ataxic form affects balance and coordination
- what tx may help to decrease spasticity in cerebral palsy?
- 1. botox injected into spastic muscles
2. Baclofen (centrally acting m. relaxant)
- what form of tx may permanetly reduce spasticity?
- 1. selective dorsal rhizotomy may permanently reduce spasticity by cutting some of the nerve fibers that are contributing most to spasticity
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