Table of contents
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Rigid Movement Disorders
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:
- Gait Impairment
- Urinary Incontinence
- 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
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Treatment
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Cholinesterase inhibitors & Memantine
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Mild-to-mod dementia (MMSE 10-26)
- Donepezil
- Rivastigmine
- Galantamine
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If Vitamins Preferred:
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Vitamin E 2000 IU daily
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- 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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