Dementia

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    Rigid Movement Disorders

    ParkinsonsDisorders.jpg

     

    Progressive Supranuclear Palsy

    • Dementia, atremulous parkinsonism, eye movement abnormalities (classically vertical gaze palsy)
      • Dementia: cognitive slowing, passivity, apathy.  (subcortical)
      • Vertical Gaze: Vertical gaze palsy, convergence insufficiency
        • Messy eating, unable to eat
        • "Square Wave Jerks" - inappropriate horizontal sacchades..
      • Parkinsonism: dystonic facial appearance, axial rigidity, gait hesitation, postural instability
    • Neuroimaging:
      • Marked atrophy of the brainstem and midbrain.
    • Pathology:
      • Widespread neurofibrillary tangle deposition throughout basal ganglia, midbrain, brainstem, cerebellum.
    • Prognosis:
      • Relentlessly progressive.. causing death from aspiration within 8-12years.
    • Source: MKSAP question

     

    Lewy Body Dementia

    • Visual hallucinations (often precede parkinsonism)
    • REM (rapid eye movement) sleep behaviour disorder
    • TODO: expand this section.

     

    Normal Pressure Hydrocephalus

    • Triad:
    1. Gait Impairment
    2. Urinary Incontinence
    3. Cognitive Impairment

     

    Vascular Parkinsonism

    • Symptoms:
      • Predominant lower extremity involvement
      • Gait impariemnt
      • Step-wise course

     

    MSA

    • Characterized by autonomic dysfunction
    • Types:
      • MSA-A - autonomic predominant
      • MSA-C - cerebellar symptoms

    Alzheimer's Dementia

    • Treatment

    • Cholinesterase inhibitors & Memantine

    • Mild-to-mod dementia (MMSE 10-26)

     

    • Donepezil
    • Rivastigmine    
    • Galantamine

     

    • If Vitamins Preferred:

      • Vitamin E 2000 IU daily

    • Mod-To-Advanced (MMSE < 17)
      • Add Memantine to cholinesterase inhibitor (or memantine alone if don’t tolerate AChE inhibitor)
    • Severe Dementia (MMSE < 10)
      • Continue memantine OR d/c medications to maximize quality of life.
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