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Creutzfeldt–Jakob disease

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Creutzfeldt–Jakob disease

Creutzfeldt–Jakob disease (CJD) is an incurable, always fatal, neurodegenerative disease belonging to the transmissible spongiform encephalopathy (TSE) group. Early symptoms include memory problems, behavioral changes, poor coordination, visual disturbances and auditory disturbances. Later symptoms include dementia, involuntary movements, blindness, deafness, weakness, and coma. About 70% of sufferers die within a year of diagnosis. The name "Creutzfeldt–Jakob disease" was introduced by Walther Spielmeyer in 1922, after the German neurologists Hans Gerhard Creutzfeldt and Alfons Maria Jakob. CJD is caused by a prion, an infectious abnormal folding of a protein. Infectious prions are misfolded proteins that can cause normally folded proteins to also become misfolded. About 85% of cases of CJD occur for unknown reasons, while about 7 % of cases are inherited in an autosomal dominant manner. Exposure to brain or spinal tissue from an infected person may also result in spread. There is no evidence that sporadic CJD can spread among people via normal contact or blood transfusions, although this is possible in variant Creutzfeldt–Jakob disease. Diagnosis involves ruling out other potential causes. An electroencephalogram, spinal tap, or magnetic resonance imaging may support the diagnosis. Another diagnosis technique is the real-time quaking-induced conversion assay, which can detect the disease in early stages. There is currently no specific treatment for CJD. Opioids may be used to help with pain, while clonazepam or sodium valproate may help with involuntary movements. CJD affects about one person per million people per year. Onset is typically around 60 years of age. The condition was first described in 1920. It is classified as a type of transmissible spongiform encephalopathy. Inherited CJD accounts for about 10% of prion disease cases. Sporadic CJD is different from bovine spongiform encephalopathy (mad cow disease) and variant Creutzfeldt–Jakob disease (vCJD).

Infobox

Other names
subacute spongiform encephalopathy, neurocognitive disorder due to prion disease, (historical) spastic pseudosclerosis
Pronunciation
UK: /ˌkrɔɪtsfɛlt ˈjækɒb/ KROYTS-felt YAK-ob, US: /- ˈjɑːkoʊb/ -⁠ YAH-kohb
Specialty
Neurology
Symptoms
Initial presentation is very variable, but the disease always progresses to akinetic mutism Classic CJD: Global cognitive decline, amnesia, acalculia, alexia, behavioral changes, aphasia, myoclonus, ataxia, pyramidal and extrapyramidal signs (3 to 12 months life expectancy) Pure cognitive variant: Amnesia, loss of executive functioning, aphasia, behavioral changes, resembles Alzheimer's disease (6 to 12 months Life expectancy) Ataxic variant: Ataxia, pyramidal and extrapyramidal signs, most common with iatrogenic CJD, resembles kuru (6 to 12 months life expectancy) Psychiatric variant: Depression, mood changes, psychosis, delusions, hallucinations, paranoia, aggression, resembles variant CJD (6 to 12 months life expectancy) Visual/Heidenhain variant: Hemianopsia, anopsia, scotoma, palinopsia, hallucinations, cortical blindness, very rapid progression (3 to 6 months life expectancy) Thalamic variant: Insomnia, paraesthesia, autonomic failure, tachycardia, hyperhidrosis, diplopia, hypertension, stridor, anisocoria, heart issues, resembles fatal insomnia (6 to 12 months life expectancy) Stroke variant: Motor presentation, extremely rapid progression, resembles a stroke (1 to 6 months life expectancy sometimes even 2-3 weeks) Corticobasal variant: Extrapyramidal signs, resembles corticobasal syndrome (8 to 24 months)
Complications
Aspiration pneumonia due to difficulty coughing and swallowing
Usual onset
Around age 60
Duration
70% die within a year of diagnosis
Types
Sporadic (unknown cause), Familial (genetics), Iatrogenic (acquired)
Causes
Type 1 or type 2 PrPCJD
Risk factors
Having at least one living or deceased ancestor with the disease (in case of familial or sporadic CJD), receiving cadaveric growth hormone or dura mater (in case of iatrogenic CJD), family history of dementia, employment as a health professional, contact with cows and sheep (in case of sporadic CJD)
Diagnostic method
Based on symptoms and medical tests after other possible causes are ruled out
Differential diagnosis
Encephalitis, chronic meningitis, Huntington's disease, Alzheimer's disease, Sjögren's syndrome
Prevention
Gene editing of children at risk (for fCJD), proper sterilization of surgical equipment (for iCJD)
Treatment
Untreatable; supportive care
Medication
Various experimental treatments, For pain relief: Morphine, Methadone
Prognosis
Life expectancy greatly shortened, varies from 3 months to multiple years
Frequency
1 per million per year
Deaths
131 in the United Kingdom (2020)

Tables

Clinical and pathologic characteristics · Diagnosis › Classification
Median age at death
Median age at death
Characteristic
Median age at death
Classic CJD
68 years
Variant CJD
28 years
Median duration of illness
Median duration of illness
Characteristic
Median duration of illness
Classic CJD
4–5 months
Variant CJD
13–14 months
Clinical signs and symptoms
Clinical signs and symptoms
Characteristic
Clinical signs and symptoms
Classic CJD
Dementia; early neurologic signs
Variant CJD
Prominent psychiatric/behavioral symptoms; painful dysesthesias; delayed neurologic signs
Periodic sharp waves on electroencephalogram
Periodic sharp waves on electroencephalogram
Characteristic
Periodic sharp waves on electroencephalogram
Classic CJD
Often present
Variant CJD
Often absent
Signal hyperintensity in the caudate nucleus and putamen on diffusion-weighted and FLAIR MRI
Signal hyperintensity in the caudate nucleus and putamen on diffusion-weighted and FLAIR MRI
Characteristic
Signal hyperintensity in the caudate nucleus and putamen on diffusion-weighted and FLAIR MRI
Classic CJD
Often present
Variant CJD
Often absent
Pulvinar sign-bilateral high signal intensities on axial FLAIR MRI. Also, posterior thalamic involvement on sagittal T2 sequences
Pulvinar sign-bilateral high signal intensities on axial FLAIR MRI. Also, posterior thalamic involvement on sagittal T2 sequences
Characteristic
Pulvinar sign-bilateral high signal intensities on axial FLAIR MRI. Also, posterior thalamic involvement on sagittal T2 sequences
Classic CJD
Not reported
Variant CJD
Present in >75% of cases
Immunohistochemical analysis of brain tissue
Immunohistochemical analysis of brain tissue
Characteristic
Immunohistochemical analysis of brain tissue
Classic CJD
Variable accumulation.
Variant CJD
Marked accumulation of protease-resistant prion protein
Presence of agent in lymphoid tissue
Presence of agent in lymphoid tissue
Characteristic
Presence of agent in lymphoid tissue
Classic CJD
Not readily detected
Variant CJD
Readily detected
Increased glycoform ratio on immunoblot analysis of protease-resistant prion protein
Increased glycoform ratio on immunoblot analysis of protease-resistant prion protein
Characteristic
Increased glycoform ratio on immunoblot analysis of protease-resistant prion protein
Classic CJD
Not reported
Variant CJD
Marked accumulation of protease-resistant prion protein
Presence of amyloid plaques in brain tissue
Presence of amyloid plaques in brain tissue
Characteristic
Presence of amyloid plaques in brain tissue
Classic CJD
May be present
Variant CJD
May be present
Characteristic
Classic CJD
Variant CJD
Median age at death
68 years
28 years
Median duration of illness
4–5 months
13–14 months
Clinical signs and symptoms
Dementia; early neurologic signs
Prominent psychiatric/behavioral symptoms; painful dysesthesias; delayed neurologic signs
Periodic sharp waves on electroencephalogram
Often present
Often absent
Signal hyperintensity in the caudate nucleus and putamen on diffusion-weighted and FLAIR MRI
Often present
Often absent
Pulvinar sign-bilateral high signal intensities on axial FLAIR MRI. Also, posterior thalamic involvement on sagittal T2 sequences
Not reported
Present in >75% of cases
Immunohistochemical analysis of brain tissue
Variable accumulation.
Marked accumulation of protease-resistant prion protein
Presence of agent in lymphoid tissue
Not readily detected
Readily detected
Increased glycoform ratio on immunoblot analysis of protease-resistant prion protein
Not reported
Marked accumulation of protease-resistant prion protein
Presence of amyloid plaques in brain tissue
May be present
May be present

References

  1. CDC
    https://www.cdc.gov/creutzfeldt-jakob/about/
  2. Practical Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520355
  3. Longman Pronunciation Dictionary
  4. NINDS
    https://web.archive.org/web/20170704234755/https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Creutzfeldt-Jakob-Disease-Fact-Sheet
  5. Annals of Neurology
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  7. Current Alzheimer Research
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  8. "Creutzfeldt–Jakob disease"
    https://www.nhs.uk/conditions/creutzfeldt-jakob-disease-cjd/
  9. Creutzfeldt–Jakob disease @ Who Named It
    http://www.whonamedit.com/synd.cfm/696.html
  10. www
    https://www.cdc.gov/prions/cjd/index.html
  11. Neurosurgical Focus
    https://doi.org/10.3171%2F2015.8.FOCUS15328
  12. New England Journal of Medicine
    https://doi.org/10.1056%2FNEJMc2000687
  13. Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee
    https://www.transfusionguidelines.org/transfusion-handbook/5-adverse-effects-of-transfusion/5-4-variant-creutzfeldt-jakob-disease-vcjd
  14. Practical Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580883
  15. CDC
    https://www.cdc.gov/prions/cjd/about.html
  16. CDC
    https://www.cdc.gov/prions/cjd/index.html
  17. reference /viewarticle/881806_3
    https://web.archive.org/web/20170706181402/http://reference.medscape.com/viewarticle/881806_3
  18. Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Prac
  19. Journal of the Neurological Sciences
    https://www.sciencedirect.com/science/article/abs/pii/S0022510X24004295#:~:text=Creutzfeldt,27029
  20. Annals of Neurology
    https://doi.org/10.1002%2Fana.410200507
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