Flashcards in 11.13 Parkinson-Plus Syndromes Deck (29)
What are some red flags that indicate a dx other than PD?
- Early postural instability/abn postures
- rapid progression
- respiratory dysfunction
- signs of cerebellar, corticospinal, voluntary gaze dysfunction
What IS Parkinson-Plus?
Collective name for primary neurodegenerative dz that causes s/s similar to PD
What are the Parkinson-Plus syndromes?
- Progressive supranuclear palsy
- Dementia with Lewy bodies
- Multiple system atrophy
Which of the Parkinson-plus syndromes is associated with accumulation of tau?
Progressive supranuclear palsy
What is CTE caused by?
Repetitive head injuries (concussions)
What are the common non-motor changes seen with CTE?
- Mood changes
- Cognitive issues
What sort of physiological changes come about with CTE?
- atrophy of cerebral hemispheres with brain volume loss
- Eventually affects the amygdala and hippocampus
How does a diffuse axonal injury occur and what does it affect?
- Shockwave from head trauma goes through the brain (connection between cell bodies and axons)
- Affects all neurons in the cortex
- Get shearing of axons away from cell bodies
What happens when there is shearing of axons from cell bodies in the CNS? How does this kill neurons?
- kills neurons via excitotoxicity
- CNS white matter forms a scar
Why is a scar in the CNS white matter problematic?
- axons can't cross the scar
- get lots of inflammation
What does CTE cause the accumulation of?
Dementia is a late presentation of this Parkinson-plus syndrome
Lewy body dementia
What is accumulated in Lewy body dementia?
Insoluble phosphorylated alpha-synuclein proteins all over the brain
Alpha-synuclein is (intracellular/extracellular)
What results from accumulation of alpha-synuclein protein with Lewy body dementia?
Symptoms of Lewy body dementia
- mood changes
- cognitive decline
- can have vivid/disturbing hallucinations
How is Lewy body dementia similar/distinct from PD?
- Lewy bodies occur FIRST (they like the SN)
- Dopaminergic cell death is SECONDARY to Lewy body formation
Why does a pt with Lewy body dementia have hallucinations?
It affects visual vortices
Can Lewy bodies occur in other disorders
- can occur in PD secondary to neuronal death
With Lewy body dementia, where is inflammation and neuronal death most significant?
What is frontotemporal dementia?
General term used to describe progressive neurodegenerative disorders that affect
- frontal lobe
- temporal lobe
Example of frontotemporal dementia
What will an MRI show with Pick's disease?
Marked loss of frontal cortex volume
What causes Pick's disease?
- thought to be a problem of clearing misfolded proteins
- Proteasome system
What s/s will be seen with Pick's disease?
- loss of executive function (FIRST)
- neurons swell in affected tissue area
Pick's disease: plaques/tangles
None seen in the disorder
Which is the most significant symptom of Pick's disease?
Loss of executive function (can overshadow memory disturbance)