Overview
Senile chorea is a condition that occurs in older adults over the age of 60 years, with large caudate and shell nuclei, degeneration of small nerve cells, and mostly uninvolved cerebral cortex. The site of brain lesions is similar to Huntington’s disease. The clinical features are acute onset, mild choreiform movements, and the only symptom, not accompanied by intellectual decline, and the dance movements sometimes appear only in the tongue, face, and buccal muscle area. In order to distinguish it from chronic progressive chorea, there is a tendency to classify it as a separate disease unit.
Etiology
Senile chorea is most often caused by vascular diseases, but may also occur in old age with hereditary diseases. The pathogenesis of the disease is unclear. Chronic progressive chorea can also develop in old age, and in addition to a family history, some cases are disseminated.
Symptoms
There is no family history of the disease, and the onset of the disease is usually over 60 years of age. The onset of the disease is rapid, and the choreiform movements are mild and the only symptom, not accompanied by intellectual decline. The choreiform movements sometimes appear only in the tongue, face and buccal muscle area, with a benign course, which can be differentiated from Huntington’s disease, and sometimes it is difficult to distinguish from sporadic Huntington’s disease. Age spots, or neuroinflammatory spots, can be found in the brain tissue of patients with senile chorea, a hereditary disease of old age.
Examination
Cerebrospinal fluid examination may reveal decreased levels of aminobutyric acid.
1. Genetics
It is an important tool for identification.
2. Electroencephalogram
There may be diffuse abnormalities without specificity. The main abnormality is low amplitude fast waves, especially in the frontal lobe, which accounts for 88.9% of the cases. alpha activity is reduced or absent, and the amplitude of waves is reduced. Visual evoked potentials are reduced in amplitude, but the first-wave partial latency is normal.
3. Imaging
CT or MRI of the head is of great clinical value in identifying Huntington’s disease.
Diagnosis
The diagnosis is usually made on the basis of onset in old age, no family history, choreiform movements as the only symptom, and no intellectual decline.
Differential diagnosis
It is mainly differentiated from disseminated cases of Huntington’s disease with onset in old age.
Complications
Cerebrovascular disease may be present in combination.
Treatment
The principle of treatment is based on Huntington’s chorea, and anti-dopaminergic drugs or dopamine receptor inhibitors are used.
1. Antidopaminergic drugs or dopamine receptor inhibitors
The main therapeutic drugs include haloperidol in butylbenzene and chlorpromazine and phenothiazine, which can block dopamine receptors. Benzamides such as thiamphenicol (Tabrizol) have anti-dopaminergic effects.
2. Increase choline content
Toxaphene inhibits central cholinesterase activity and prevents choline degradation, which may improve choreiform movements.
3.Others
It can assist the application of neurological metabolism-promoting drugs, vitamins and energy combining agents. Anti-free radical, antioxidant and anti-cellular excitotoxicity therapy may also have some efficacy. In addition, the strengthening of limb function training and psychotherapy may also have good therapeutic effect. If it is caused by vascular disease, it can be treated with improving cerebral blood circulation.