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NCS Prep > 9 Parkinson's Disease > Flashcards

9 Parkinson's Disease Flashcards

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1
Q

Basal ganglia components

A 
Caudate
Putamen
Globus pallidus (internus and externus)
Subthalamic nucleus
Substantia nigra (pars compacta and pars reticulata)
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2
Q

Striatum

A

Caudate and putamen

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3
Q

Lentiform nucleus

A

Globus pallidus and putamen

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4
Q

Basal ganglia function

A

Regulates movement via control of sequencing, muscle tone, muscle force
Communicates through thalamus to cortex
To lower motor neurons via pedunculopontine nucleus of midbrain

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5
Q

Basal ganglia neurotransmitters

A

GABA (inhibitory)
Glutamate (excitatory)
Dopamine (both)

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6
Q

Function of direct pathway in BG

A

Facilitates movement

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7
Q

Nigrostriatal impact in the direct pathway

A

Dopamine acts as an excitatory NT by binding to D1 receptors, further exciting stratum leading to dis-inhibition of thalamus and increased motor activity

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8
Q

Function of indirect pathway in BG

A

Suppresses unwanted movement

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9
Q

Nigrostriatal impact in the indirect pathway

A

Dopamine acts as an inhibitory NT by binding to D2 receptors, inhibiting striatum leading to reduced inhibition of thalamus and increased motor activity

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10
Q

Parkinson’s disease definition

A

Chronic, progressive CNS disorder that results from death of dopamine-producing cells in substantia nigra

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11
Q

Direct pathway effect in PD

A

Less dopamine results in decreased facilitation of motor output

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12
Q

Indirect pathway effect in PD

A

Less dopamine results in increased inhibition of (decreased) motor output- less output occurs because there is more movement suppression

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13
Q

Cellular mechanisms of PD

A 
Oxidative stress
Accumulation of toxic proteins
Mitochondrial malfunction
Inadequate neurotrophic factors (GDNF)
Inflammatory glia
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14
Q

Environmental/dietary factors in PD

A

Pesticides and herbicides, heavy metals
Smoking, caffeine, possibly alcohol protect
Antioxidants, dairy/milk, iron possible positive association

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15
Q

PD from genetic cause

A

Younger onset, dystonia, early dementia

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16
Q

Cardinal signs of PD

A

Tremor (70%, begins unilaterally)
Rigidity (cogwheel or leadpipe- proximal, extends distal)
Akinesia/bradykinesia
Postural instability

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17
Q

Other motor signs and symptoms of PD

A 
Freezing of gait
Forward flexed posture
Incoordination (gross and fine)
Hypomimia (facial expression)
Dystonia
Dysarthria
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18
Q

Non-motor signs and symptoms of PD

A 
Loss of smell
Sleep disturbances
Mood disorders
Dysautonomia
Constipation
Depression
Dysphagia
Hypophonia
Micrographia
Sialorrhea
Cognitive dysfunction
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19
Q

Dementia with Lewy bodies

A

Misfolded alpha-synuclein proteins (Lewy bodies) are hallmark of PD
Progressive dementia- deficits in attention and executive function
Fluctuating cognition
Visual hallucinations

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20
Q

Primary Parkinsonism

A

85% of all PD cases
Unilateral onset, slow progression
Tremor dominant- more favorable prognosis, relative preservation of mental status, earlier age of onset
Postural instability/ gait disturbance- more rapid progression, severe cog dysfunction, two variants (postural instability with falling and freezing of gait)

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21
Q

Diagnostic criteria for primary Parkinsonism

A

Clinical diagnosis
Presence of at least 2/4 cardinal signs
Positive levodopa response
Other causes ruled out

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22
Q

Types of secondary Parkinsonism

A

Vascular
Drug-induced
Infection
Toxins

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23
Q

Vascular Parkinsonism

A

One or more small strokes
LE and gait more affected
Rest tremor uncommon
Scarce response to levodopa

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24
Q

Drug-induced Parkinsonism

A

From neuroleptic/anti-psychotic meds
Symmetrical presentation
Orolingual dyskinesia, tardive dyskinesia, or akathisia may be present
Ceasing meds can reverse symptoms, can take up to 2 years

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25
Infection-induced Parkinsonism
Encephalitis Influenza HIV Meningitis
26
Toxin-induced Parkinsonism
``` Carbon monoxide Heavy metals (manganese, copper, lead) Mercury (tremor) MPTP Toluene (paint thinners, adhesives) ```
27
Parkinson-plus syndromes
Progressive supranuclear palsy Multiple system atrophy Corticobasalganglionic degeneration
28
Progressive supranuclear palsy
Early postural instability and falls Vertical gaze paresis Difficulty controlling eyelids (PSP stare) 5.3 year survival
29
Multiple system atrophy
PD-symptoms, plus autonomic dysfunction and cerebellar dysfunction 8.5 year survival
30
Corticobasalganglionic degeneration
``` Focal rigidity Marked dystonia (usually one arm) Limb apraxia Alien hand syndrome PD-symptoms 6-8 year survival ```
31
Modified Hoehn and Yahr Scale
0- no disease 1- unilateral 1.5- unilateral and axial 2- bilateral, no balance impairment 2.5- mild bilateral disease with recovery on pull test 3- balance impairment. mild-mod disease. independent. 4- severe disability, but can stand and walk unassisted 5- needs wheelchair or bedridden unless assisted
32
MDS-UPDRS Motor
Items 0-4 (normal to severe impairment) | Speech, facial expression, tremor, rigidity, coordination, transfers, posture, gait, postural stability, bradykinesia
33
Sinemet facts
Levodopa- precursor to dopamine that can cross blood-brain barrier Carbidopa- prevents levodopa from converting in periphery Side effects- nausea, drowsiness, orthostatic hypotension, dyskinesia, motor fluctuations, hallucinations Protein can slow absorption
34
On-off times effect
Dyskinesia- at peak dose | Off- no symptom management between doses
35
Other PD meds
``` Dopamine agonists COMT inhibitors MAO type-B inhibitors Anticholinergics Amantadine ```
36
Dopamine agonists
Initial or adjunct therapy- delay or reduce motor fluctuations and dyskinesia Longer half-life than Sinemet but not as effective Mirapex, Requip, Neupro
37
COMT inhibitors
Prevent peripheral degradation of levodopa May decrease "off" time or dosage Comtan, Tasmar
38
MAO type-B inhibitors
Block breakdown of dopamine in brain | Selegiline, Rasagiline
39
Anticholinergics
Inhibit dopamine reuptake in striatum Mainly for tremors and rigidity Artane, Cogentin
40
Amantadine
Dopamine agonist and dopamine reuptake inhibitor Often used to treat dyskinesia Symmetrel, Kemadrin
41
Symptoms unresponsive to meds
Postural instability Freezing Mental changes ANS dysfunction
42
Deep brain stimulation
Electrodes in brain connected to implantable pulse generator in chest Minimize "off" times and dyskinesia, lower dosage of meds Results no better than "on" time For idiopathic PD only Intact cog function, good dopamine response
43
Target sites for DBS
Thalamus- reduces tremor, no other symptoms Globus pallidus internus or subthalamic nucleus- reduces tremor, rigidity, bradykinesia, dyskinesia STN DBS- better ADLs in "off" times, greater med reduction
44
Dopamine's effect on limbic functions
Low- depression, apathy, anhedonia, anxiety | High- euphoria/ mania, impulsivity, pleasure-seeking/risk-taking behavior
45
Depression in PD
Most common psychiatric symptom in PD- 40% | Depressed mood, diminished interest/pleasure, fatigue, sleep changes, poor concentration, change in appetite
46
Exercise effects in PD
May delay or prevent PD in healthy individuals | May slow disease progression and motor deterioration in early PD
47
High-intensity exercise for PD
More normal corticomotor excitability | Lengthened cortical silent period (more normal corticomotor excitability)
48
Forced use cycling effects
Improvement in UPDRS-motor, bimanual dexterity, rigidity, bradykinesia Greater reliance on feedforward vs feedback processes- shifts central motor control processes Forced exercise has similar effects on symptoms as meds do
49
Individual vs group treatment for PD
Individual- best for balance and function improvements | Group- best for gait
50
Treadmill training for PD
Improved gait parameters Improved balance and motor performance Improved QOL Reduced fatigue
51
Boxing for PD
Improved balance, gait, disability, QOL | Mild-mod PD
52
Dancing for PD
Tango slightly superior Partnered dancers more compliant Mild-mod PD
53
Tai chi for PD
Improve postural stability, reduce falls, improve motor function, improve QOL Inconsistent effects on gait
54
Dual-task training for PD
Best for mild-mod PD | Improves gait and balance in dual task, and in single-task gait
55
How strategies work
Bypass basal ganglia via cortical, cerebellar, or brainstem pathways to normalize movement Shifts to explicit learning vs implicit
56
BESTest
``` 36-item balance assessment Biomechanical constraints, stability constraints Anticipatory postural adjustments Reactive postural responses Sensory orientation Stability in gait Score 0-3 (severe to normal) Max score 108, converted to percentage Cut-off <69% for fall risk ```
57
Mini-BESTest
``` 14-item scale 0-2 (severe to normal) Max 28 Use AD lowers each item by 1 point Score of 0 if needs assistance <23/28 is fall risk ```
58
Freezing of gait questionnaire
6-item, to be given during "on" state 0 (no symptoms) to 4 (most severe) Total 0-24 (high score is severe freezing) Based on past week or overall presence of FOG throughout day
59
Parkinson's disease questionnaire-39
Self-report, QOL Experience over past month Mobility, ADLs, emotional well-being, stigma, cognition, communication, bodily discomfort 0 (never) to 4 (always)
60
Treatment of freezing of gait
Improve weight shifting External cueing Exercise in small spaces Dual task training
61
Trail-making test involves
Attention shifting

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