exam #2 - PD Flashcards
PD is the most common _________ disorder
-1 million Americans
-average age onset ____ - ____ yrs. old
-young onset _____ - ____ yrs. old
-juvenile-onset <___ yrs. old
-more common in males or females?
neurodegenerative
50-60
21-50
<21
male
Etiology: disturbance in the ________ system in the _______ ______
-typically less DA in the ______
dopamine (DA); basal ganglia
substania nigra
most common type of PD:
& subtypes
idiopathic (78%)
-postural instability gait disorder (PIGD)
-tremor dominant (TD)
Other types of PD:
genetic
secondary parkinsonism
atypical parkinsonism (Parkinson’s Plus Syndrome)
PIDG vs TD:
PIDG:
worse diagnosis
more bradykinesia
higher prevalence of non-motor symptoms
higher likelihood of dementia
TD:
better prognosis
less difficulty with bradykinesia and postural instability (less falls)
lower incidence of non-motor symptoms
lower risk of developing dementia
Genetic markers:
-_____% of cases are genetic
-some families share gene ______
-two types –>
—those that cause _____
—those that increase risk of _________
10%
mutations
PD
developing it
Secondary Parkinsonism Types: (2)
toxic parkinsonism
drug-induced parkinsonism
Toxic Parkinsonism: exposure to certain toxins or chemicals
exposed to pesticides, industrial chemicals –> agent - orange military
–manganese most common - miners often exposed
synthetic heron with chemical MPTP
Drug-induced Parkinsonism are drugs that interfere with the _______
dopaminergic systems
–neuroleptic drugs, antidepressants, some antihypertensive (wrong dosage shows PD symptoms)
PD Plus Syndromes Differential:
-don’t often respond to _____
-early onset of _______
-_________ in early stages
-_______ symptoms more prominent than limb symptoms
-_______signs present
-_________ symptoms more prevalent like ________
-levodopa
-postural instability and/or dementia
-more symmetry in early stages
-trunk
-ocular
-autonomic; postural hypotension or incontinence
Progressive Supranuclear Palsy (PSP):
rapid progression (3-5 years)
starts in late middle age
tremor is rare
emotional changes
limitations in vertical gaze (difficulty looking down)
difficulty keeping eyelids open
UMN only
have extension pattern rather than flx
NOT synonymous with ALS
Patients will lose balance backwards
Multiple System Atrophy (MSA):
orthostatic hypotension is common
less cognitive involvement
may have ataxia
will have MRI visible denigration in BG
ANS symptoms are more noticeable
progresses faster (6-8 years)
starts in late 50s
has motor symptoms like PD
doesn’t respond to levapoda
Aka shy Drager Syndrome
Corticobasalganglionic Degenration (CBD):
progresses quickly 6-8 years
a form of frontotemporal degeneration w/dementia component
loss of graphthesia
often present in one UE
“alien limb”
upgaze and horizontal gaze impaired but NOT downgaze
Lewy Body Dementia (LBD):
get deposits of alpha-synuclein in brain
having PD increases your risk of this
cognitive fluctuations
mood changes
early change in cognition
visual hallucinations
rigidity more severe
lack of asymmetry
median survival is 8 years
ALS is UMN or LMN?
____ is a disorder of the myelin, not a neurotransmitter or the BG
both UMN and LMN
MS
structures within the basal ganglia: (5)
Pathophysiology of PD:
-degeneration of dopaminergic neurons produces less ______
can get alpha-synuclein cytoplasmic inclusions (LBD) as the disease progresses
-_____ loop - signals from the BG go to the thalamus, then the cortex
caudate nucleus
putamen
globus pallidus
subthalamic nucleus
substantia nigra
dopamine (DA)
direct
PD: Direct Loop
-excitation putamen to globus pallidus (GP)
-GP to ventral lateral nucleus of thalamus
-VL nucleus of thalamus to supplemental motor area (SMA) of cortex
result: voluntary motor movement and positive feedback loop –> need dopamine from substantia nigra to help w/activation
PD = regular indirect pathway (inhibitory) + affected direct pathway (excitatory turned inhibitory) which leads to _____
bradykinesia (slowness of movement)
-excessive inhibition of the thalamus by the GPi/SNr (via the indirect pathway) and reduced facilitation of movement initiation (via the direct pathway).
cardinal motor symptoms of PD:
bradykinesia (low speech)
resting tremor
rigidity (cogwheel, lead pipe)
postural instability
Other motor S&S
muscle performance:
motor function:
gait:
dysphagia:
hypokinetic dysarthria:
muscle performance: delayed recruitment
motor function: difficulty w/speed and accuracy of task, dual tasking, starting/stopping motion
gait: up 25% initial symptoms, bradykinesia, flexed posture, decreased arm swing, freezing possible
dysphagia: 95% will have difficulty swallowing due to rigidity \
hypokinetic dysarthria: talk quieter
Non-Motor Symptoms: (4 clusters)
- rapid eye movement sleep behavior disorder
- cognition related
- mood related
- sensory and dysautonomia
rapid eye movement sleep behavior disorder:
frequent nightmares
dream enacting behavior (talking/walking in sleep)
insomnia (can’t sleep @ night)
cognition related symptoms:
memory complaints
cognitive fatigue
inattention (open vs. closed environments)
excessive day-time sleepiness
mild cognitive impairment –> difficulty w/dual tasks
mood-related symptoms:
anhedonia (lack of joy in things), apathy, flat affect (face shows no emotion), depression(40%), anxiety (31%), etc.
