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Flashcards in Basal Ganglia Disorders Deck (51)
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1

Most common basal ganglia diseases:

Parkinson’s disease, Huntington Chorea and dystonias (including drug induced dyskinesias)

2

What do basal ganglia involve impairments in:

Muscle tone
Movement coordination and motor control
Postural stability
Presence of extraneous movement

3

What are dorsal or sensorimotor basal ganglia composed of:

Caudate nucleus
Putamen
Globus pallidus

4

What are the two brainstem nuclei involved?

Substantia nigra
Subthalmic nucleus

5

Relationship of the BG to Movement and Posture:

Automatic Movement
Motor Problems
Movement initiation and preparation
Postural Adjustments
Perceptual and Cognitive Functions

6

What do basal ganglia diseases result in?

difficulty initiating, continuing, or stopping movement
difficulty with muscle tone (particularly rigidity), and increased involuntary movements (tremor, chorea

7

Symptoms of basal ganglia disease:

Movement changes, such as involuntary or slowed movements
Increased muscle tone
Muscle spasms and muscle rigidity
Memory loss
Problems finding words
Tremor
Uncontrollable, repeated movements, speech, or cries (tics)
Walking difficulty

8

Parkinson’s Disease

Chronic progressive disease of the CNS with degeneration of dopaminergic substantia nigra neurons and nigrostriatal pathways

9

What does the loss of inhibitory dopamine result in?

excessive excitatory output from cholinergic system (acetycholine) of BG

10

Earliest signs of PD:

occur in the enteric nervous system
Medulla: particularly the olfactory bulb
NON-motor symptoms can precede motor symptoms

11

Classic symptoms of PD:

Rigidity (leadpipe or cogwheel)
Bradykinesia (hypokinesia)
Resting tremor
Impaired postural reflexes

12

When does resting temor appear?

Appears when muscles are relaxed: when hands are in lap or arms loosely held at the side

13

Where is resting tremor most common?

unilateral hand or foot

14

What exacerbates resting tremor?

stress or excitement

15

Rigidity:

Inflexibility & stiffness of limb, neck & trunk

16

Where is rigidity most common in PD?

neck, shoulder, and leg

17

Rigidity can lead to:

decreased ROM
decreased arm swing
pain/discomfort

18

Secondary Motor Symptoms:

Freezing
Micrographia
Mask-Like Expression
Unwanted Accelerations
Stooped posture
Dystonia
Swolling difficulty
Slurred speech
Soft speech

19

Pre-Diagnostic Signs of PD

Olfactory function
PD patients prefer sweets!
Autonomic function
Incontinence, constipation, erectile dysfunction
Sleep function
REM sleep disorder
Vivid dreams/acting out dreams
Emotional/Cognition
Depression, Apathy

20

Hoehn and Yahr 1:

unilateral involvement, usually with minimal or no functional disability

21

Hoehn and Yahr 2:

bilateral or midline involvement without impairment of balance

22

Hoehn and Yahr 3:

bilateral disease: mild to moderate disability with impaired postural reflexes; physically independent

23

Hoehn and Yahr 4:

severely disabling disease; still able to walk or stand unassisted

24

Hoehn and Yahr 5:

confinement to bed or wheelchair unless aided

25

Best prognosis in PD:

non-demented & tremor predominant cases of PD

26

Predictive factors for more rapid motor progression, nursing home placement, and shorter survival of PD:

Older age of onset
Comorbidities
Rigidity/bradykinesiaphenotype
Decreased responsiveness to dopamine
Dementia

27

Cognitive/Behavioral Status of PD:

Intellectual impairments/Dementia occurs in advanced stages
Memory
Bradyphrenia (slowing of thought processes)
Depression

28

Communication in PD:

Dysarthria
Hypophonia (decreased volume)
Mutism in advanced stages
Mask like face with infrequent blinking and expression
Writing becomes progressively smaller

29

Oromotor Control/Nutritional Status

Dysphagia
Problems in chewing and swallowing

30

Respiratory Status

Breathing patterns
Vital capacity
Decreased chest expansion