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Parkinsonism and dementia

Parkinsonism and dementia. Parkinsonism. “Parkinson’s Disease” Idiopathic and common. Diverse causes of parkinsonism Drug-induced parkinsonism. Certain toxins Certain complex degenerative diseases Wilson’s disease. Parkinson’s Disease. Parkinson’s disease: pathology.

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Parkinsonism and dementia

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  1. Parkinsonism and dementia

  2. Parkinsonism • “Parkinson’s Disease” • Idiopathic and common. • Diverse causes of parkinsonism • Drug-induced parkinsonism. • Certain toxins • Certain complex degenerative diseases • Wilson’s disease

  3. Parkinson’s Disease

  4. Parkinson’s disease: pathology • Cell degeneration in the substantia nigra; Lewy bodies. • Loss of dopamine. • Unopposed actions of acetylcholine cause much of the rigidity.

  5. Cross section of the mid-brain Aqueduct Pyramidal tract Substantia nigra

  6. Symptoms and signs • Tremor: coarse ‘pill rolling’. Worse with emotion. May disappear during sleep. Disappears during movement. • Rigidity: ‘lead pipe’ or ‘cogwheel’. • Akinesia: difficulty initiating movement. • Postural change and festinating gait. • Speech: monotonous.

  7. Natural history • Progression at varying rates in different patients. • Usual course ~ 10 to 15 years. • Death from pneumonia.

  8. Differential diagnosis. • There are no laboratory or imaging tests that help. The diagnosis is entirely clinical. • The physician needs to be vigilant for parkinsonism as a part of more complex degenerative diseases.

  9. Aims of treatment • Prolong life • No drug has yet been shown to affect mortality. • Restore function for as long as possible • Provide community support • Safety at home • Social work • Physiotherapy

  10. Parkinsonian syndromes

  11. Drug induced parkinsonism • Drugs for schizophrenia are dopamine antagonists. • If given chronically they predictably cause parkinsonian adverse effects. • Critically: one cannot manage such patients with dopamine agonists. Instead we use anticholinergic drugs.

  12. Toxins • MPTP is a minor contaminant of synthetic opiates. • It is removed from pharmaceutical products. • But may sill contaminate illicit drug. • Very potent and often irreversible damage causing parkinsonism

  13. Parkinsonism as part of a ‘bigger’ syndrome • Rare degenerative CNS syndromes: e.g. progressive supranuclear palsy • Parkinsonism • Dementia • Ophthalmoplegia • Wilson’s disease • Inherited abnormality of copper m’lism • Parkinsonism and liver disease

  14. Dementia

  15. Definitions • ‘Delirium’: acute confusional state • Usually not the result of brain pathology, but of diverse systemic problems. • ‘Dementia’: brain disease leading to disturbed higher cortical function. Usually progressive and leading to gross disability. • Memory loss • Disorientation • Disordered thinking

  16. Alzheimer’s disease • Common (especially in elderly) • Unknown aetiology. • Insidious onset, slow development. • May be a family history. • Patients with Down’s syndrome at particular risk.

  17. Vascular dementia • Case definitions rely on history of previous stroke or TIA. • Imaging may help distinguish from Alzheimer’s.

  18. Diagnosis and management • Alert comes from family. • May present ‘cold’: referral to neurologist or psychologist. • Often presents ‘hot’: A&E failure to cope. • Imaging shows cortical atrophy. • Important to exclude depression

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