Parkinson's disease and alzheimer's disease

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Parkinson's disease and alzheimer's disease

  1. 1. PARKINSON’S DISEASE
  2. 2. INTRODUCTION Parkinson’s disease is a chronic neurodegenerative movement disorder affecting voluntary and emotional movements and most commonly seen in the elderly, but is also found in the young and inexorably progresses leading to significant disability.
  3. 3. EPIDEMIOLOGY  Primarily a disease of the elderly  Mean age 55, Range 20 - 80 years  Juvenile parkinsonism- Less than 20 years  M/F = 3:2  Prevalence increases with age
  4. 4. PATHOPHYSIOLOGY
  5. 5. SYMPTOMS Tremors Rigidity Bradykinesia Postural instability Dementia Sialorrhoea 5
  6. 6.  Tremors – hands and head develop involuntary movements when at rest; pin-rolling sign (finger and thumb)  Muscle rigidity – arthritis-like stiffness, difficulty in bending or moving limbs; poker face  Brandykinesia – problems chewing, swallowing or speaking; difficulty in initiating movements and controlling fine movements; walking becomes difficult.  Postural instability – humped over appearance, prone to falls
  7. 7. Chemical Balance in Corpus Striatum  Excitatory Cholinergic pathway BALANCE  Inhibitory Dopaminergic pathway
  8. 8. Chemical Balance in Corpus Striatum  Excitatory Cholinergic pathway Imbalance  Inhibitory Dopaminergic pathway
  9. 9. Parkinson’s disease - Pathophysiology
  10. 10. CAUSES  Unclear, but is a number of factors: – Environmental – toxins – Free Radicals – there is a increase in postmortem brain sections – Aging – age related decline in dopamine production – Genetic – possible, no single gene identified
  11. 11. TREATMENT  The Drugs: – Dopaminergic drugs (improving dopamine functioning) • Levodopa • Dopamine receptor agonists • Amantadine • Selective monoamine oxidase B inhibitors • Catechol-O-methyltransferase inhibitors – Antimuscarinic drugs (Ach inhibitors)
  12. 12. Levodopa (Madopar & Sinemet)  Can not administer dopamine directly, as it does not cross the blood brain barrier  A natural amino acid that the brain converts into dopamine (replacement therapy) used since the 1960’s  To make it slow release, combined with benserazide (an enzyme inhibitor) to create cobeneldopa or co-careldopa (Sinemet)  Dose = 50, 100 or 200mg (12.5, 25 or 50mg)
  13. 13. Surgical treatment  Deep brain stimulation  Pallidotomy
  14. 14. ALZHEIMER’S DISEASE
  15. 15. What is Alzheimer’s disease (AD) ? Alzheimer’s disease is an neurodegenerative, irreversible, progressive brain disease that slowly destroys memory and thinking skills. Although the risk of developing AD increases with age – in most people with AD, symptoms first appear after age 60 – AD is not a part of normal aging. 15
  16. 16. PATHOLOGY  The main pathological feature of AD comprise;  Deposition of β Amyloid protein(Aβ) in selective areas of brain like cortex , hippocampus , Amygdala .  Intraneuronal neurofibriliary tangles which comprises of the aggregates of highly phosphorylated form of normal neuronal protein (Tau).  Marked decrease in choline acetytranferase and loss of cholinergic neuron in brain. 16
  17. 17. video 17
  18. 18. CURRENT TREATMENT Class Drug Nootropics Piracetam Metabolic Enhancer Nicergoline Cholinergic activators Tacrine Vasoactive central protector Pyritinol 18 03/01/2014

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