 |
 |
Extrapyramidal Signs in Dementia: What do they Mean? http://www.bcm.tmc.edu/neurol/struct/adrc/adrc6.html Alzheimer's disease (AD) is not the only illness that causes progressive dementia. Other less common degenerative diseases of the brain may also produce intellectual decline. Alzheimer's disease may sometimes coexist with other conditions to give an atypical presentation. When memory loss or disorientation is associated with extrapyramidal signs (EPS) such as muscle stiffness, slowness of movement, postural instability, gait imbalance, and tremor, special attention is needed to rule out conditions other than AD. A precise diagnosis is essential for proper management of care and planning for the future. When EPS occur before the onset of dementia and the patient's slowness and stiffness respond to treatment with medication, Parkinson's disease is the most likely diagnosis. Other patients experience a rapid progression of gait imbalance, slowness of movement, muscle stiffness, and dementia, and unfortunately, do not respond well to treatment. These patients may have degeneration of brain cells caused by progressive supranuclear palsy, striatonigral degeneration or Creutzfeldt-Jakob disease. If the condition has a strong family history, Huntington's disease, Wilson's disease and Hallervorden-Spartz disease should be considered. Additionally, multiple small strokes can sometimes damage the brain and cause the appearance of EPS and dementia in patients. Most of these disorders, with their unique cognitive changes, can be distinguished from AD by a careful neurological examination and a comprehensive neuropsychological evaluation. Recently, several distinctive clinical features have been linked to a condition called "diffuse Lewy body disease" (DLBD) that was frequently mistaken for AD in the past. Cognitively, patients with DLBD are usually only mildly affected, but they may have fluctuations in their performance that exceed normal day to day variations. Visual hallucinations, unexplained falls, dizziness and EPS may be prominent and occur in early stages of the disease. The patients may also exhibit changes in personality ( i.e. lack of interest and depression), and difficulties with thinking ( i.e. problems with attention, abstract thinking, decision-making, and reality). The duration of illness is usually shorter for patients with "diffuse Lewy body disease" than for those with AD. Distinctive differences are also evident when brain tissue is examined at autopsy. Both AD and Parkinson's disease are relatively common in the elderly and one patient may be diagnosed with both illnesses. Treatment of Parkinsonian features, such as tremor, slowness and muscle stiffness, may improve the patients' quality of life substantially. Another possible variant of AD, "Alzheimer's disease with extrapyramidal signs," is not well understood. These patients experience a more rapid deterioration of their symptoms, are frequently depressed, and unfortunately, do not respond to anti-Parkinsonian treatment. In summary, the presence of EPS in persons with dementia usually suggests something atypical and patients may require more assistance and care. A comprehensive evaluation is essential because the degree of severity and the course of the illness may vary considerably. Even with proper diagnosis and treatment, many questions remain unanswered. How similar and different is AD from other dementing illnesses? What are the causes of these devastating disorders? At this time, the examination of brain tissues for large numbers of patients with dementia is critical. Pathological findings can provide clues as to how and why the brain is damaged. Such information will be invaluable to the eventual discovery of a treatment, or even a cure, for Alzheimer's disease and other degenerative diseases of the brain. Hopefully, exciting breakthroughs will occur in the very near future. _/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/ _/ _/ _/ Central Supply & Services _/ _/ (Internet Training and Research) _/ _/ PO Box 57247, Jackson Stn., _/ _/ Hamilton, Ontario, Canada, L8P 4X1 _/ _/ John S. Walker _/ _/ Email [log in to unmask] _/ _/ _/ _/ "To Teach is to touch a life forever" _/ _/ On the Web one touch can reach so far! _/ _/ _/ _/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/