Quiz 21: Pharmacotherapy of Degenerative Diseases of the Central Nervous System


Parkinson's disease (PD) is the second most common nervous system degenerative disease and third most common neurologic disorder of older adults. It is a debilitating disease which is characterized by resting tremor, muscle rigidity, hypokinesia, slow, shuffling gait and masklike faces. PD has two etiologies like idiopathic and secondary. Idiopathic PD is the most common type for which there is no exact cause and is characterized by the destruction of neurons in specific regions of brain progressively. This is due to family history and genetic link. Secondary PD is caused by the medical conditions like head trauma, brain tumors infections and neurotoxins exposure. It is also caused by the usage of anti-psychotic drugs. The patient initially has subtle symptoms like feeling tired, moving more slowly and a slight tremor along with fatigue. As disease progresses, the four cardinal PD signs are tremor, muscle rigidity, bradykinesia and postural instability.

Catecholamines are monoamines derived from the amino acid tyrosine. Dopamine belongs to a class of natural hormones called catecholamines and it has inhibitory function by slowing the impulse flow down the spinal neurons. The other two major catecholamines which are found in the nervous system are epinephrine also called adrenaline and norepinephrine also called as noradrenaline.

The most common type of dementia is Alzheimer's disease which leads to the progressive loss of cognitive function. Dementia is a chronic, degenerative disorder and it is characterized by loss of memory progressively, confusion, unable to communicate and think properly. Alzheimer's disease is a neurodegenerative disease which is characterized by chronic and progressive loss of cognitive function. The information that should be included in the initial assessment in order to determine a diagnosis for Mary are whether there is loss of short-term memory, mood swings and behavioral changes when she becomes angry or frustrated, whether she forget how to perform the normal daily practices like bathing, cooking or toileting, whether there is any metabolic disorder like hypothyroidism and vitamin B12 deficiency, human immunodeficiency virus infection or other severe infections.

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