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
