L35 and 36

Question 1

How is the basal ganglia involved in motor control?

Answer 1

Influences the output of cerebral cortex

Question 2

Neural activity arriving to the BG may be important for the ___ and ___ in motor selection

Answer 2

what and where

Question 3

What does the ventral division of the basal ganglia include??

Answer 3

Nucleus accumbens
Substantia innominate
Nucleus Basalis of Meynert
Olf Tubercle

Question 4

What structure serves as the efferent pathway for the basal ganglia?

Answer 4

Parabrachial Pontine Reticular

Question 5

What symptoms are associated with damage to the Parabrachial Pontine Reticular (PPR)

Answer 5

Postural instability
Gait abnormalities
Changes in arousal, attention

Question 6

What are the two loops of the BG?

Answer 6

1) Cortical
2) Subcortical

Question 7

True or False: The Cortical Loop of the BG has diffuse inputs from the BG

Answer 7

True

Question 8

How does one get into the basal ganglia cortical loop? out of?

Answer 8

In - neo striatum (putamen/caudate)
Out - globus pallidus / sub nigra / pars reticulata / thalamus

Question 9

The superior colliculus and the pedunculopontine nucleus are part of which loop of the basal ganglia?
A. Cortical
B. Subcortical

Answer 9

B. Subcortical

Question 10

Which pathway begins as excitatory projection from
cerebral cortex to neostriatum?

Answer 10

Direct

Question 11

In the direct pathway, striatum inhibits cells in ___ and ____

Answer 11

globus pallidus internal (GPint) and SNpr

Question 12

In the direct pathway, how do the pallido-thalamic fibers (which project to the thalamus) affect the thalamic targets?

Answer 12

Tonically inhibit

Question 13

What is the net effect of the direct pathway?

Answer 13

1) Increase activity of thalamus
2) Excite cerebral cortex

Question 14

Which pathway includes a loop through both the GP and the SubThN + striatum activates GPex?

Answer 14

Indirect pathway

Question 15

Which NT does the GP use?

Answer 15

GABA

Question 16

In the indirect pathway, the globus pallidus tonically inhibits the ____, its target

Answer 16

SubThN

Question 17

True or False: The direct pathway is associated with increased firing rates of fibers from subthalamic nuclei to GPing

Answer 17

False - this occurs in the Indirect Pathway!!

Question 18

True or False: In the indirect pathway, GPint is naturally inhibitory to thalamus

Answer 18

True

Question 19

What is the net effect of the indirect pathway?

Answer 19

1) Decreased activity of thalamus
2) Decreased activity of cerebral cortex

Question 20

Dopaminergic neurons from __ project
onto striatal neurons

Answer 20

SNpc (substantia nigra - pars compacta)

Question 21

Neostriatal neurons expressing __ receptors
give rise to the direct pathway and SNpc
projections EXCITATE the direct pathway.

Neostriatal neurons belonging to the indirect
pathway have __ receptors. When dopamine
binds to __ receptors, neurons are inhibited.
INHIBITION of the indirect pathway

Answer 21

D1; D2; D2

Question 22

What is the effect of dopaminergic stimulation on
striatal neurons?

Answer 22

Facilitate movement via: both direct and indirect pathways

Question 23

True or False: The “where” options in motor selection may
be modulated by dopaminergic inputs

Answer 23

False - the “when”

Question 24

PD is caused by loss of dopamine producing cells in the ____

Answer 24

basal ganglia (substantia nigra - pars compacta)

Question 25

True or False: The severity of one's PD correlates well with extent of degeneration of dopaminergic neurons in the substantia nigra pars compacta

Answer 25

True

Question 26

True or False: A large portion of SN cells may be loss before motor symptoms are evident

Answer 26

True

Question 27

Parkinson Disease as an example of a _____ disorder A. hyperkinetic B. hypokinetic

Answer 27

B. hypokinetic

Question 28

In PD, there is loss of SNpc input to striatum. What is the result of this?

Answer 28

Increased inhibition of the motor thalamus (VA, VL)

Question 29

True or False: In PD, connections between thalamus and motor areas of the cortex are hyperactive

Answer 29

False - hypoactive

Question 30

Why is the direct pathway disengaged in PD?

Answer 30

Loss of tonic facilitation of striatal neurons bearing D1 receptors

Question 31

In PD, there is a loss of tonic inhibition of striatal neurons bearing D2 receptors. What is the effect of this?

Answer 31

1) Increased activity of striatal inhibitory connections 2) Disinhibition of sub-thalamic nucleus

Question 32

True or False: In PD, there's a loss of tonic inhibition of striatal neurons bearing D2-R. As a result of this, the VA/VL of thalamus is inhibited, motor cortex/CST activity is reduced (hypokinetic signs)

Answer 32

True

Question 33

True or False: Patients who have hypokinetic symptoms and response to levodopa have PD

Answer 33

True

Question 34

_____ is a type of PD that is relative, non-motor symptom sparing ____ is a type of PD that has more postural instability, gait difficulty (associated with worse prognosis, older onset, and mild cognitive impairement)

Answer 34

Tremor Dominant PIGD (Akinetic)

Question 35

Which form of PD is associated with higher prevalence of freezing gait, hallucinations, daytime somnolence, and REM sleep disorder?

Answer 35

PIGD

Question 36

True or False: Men are more likely to develop PD

Answer 36

True

Question 37

A change in the SNCA gene can change the ___ ____ protein, leading to clumps of it (Lewy Bodies)

Answer 37

alpha-synuclein

Question 38

Which two environmental toxins may contribute to PD?

Answer 38

1. MPTP 2. MPPP

Question 39

Which factors are related to higher risk of PD?

Answer 39

- well water - rural - head injury - meth use - melanoma

Question 40

Which factors lower one's risk of developing PD?

Answer 40

- cigarettes and ETOH use - caffeine - CCB - green and black tea

Question 41

True or False: ETOH use may elevate urate levels. Urate may be protective to dopamine-producing neurons

Answer 41

True

Question 42

What are the four cardinal features of sporatic PD?

Answer 42

1. Tremor (resting) 2. Rigidity 3. Bradykinesia 4. Postural Instability

Question 43

Which type of PD always starts unilaterally (and first side is always the more involved side)?

Answer 43

Sporadic PD

Question 44

Hyposmia may be present during which stage of PD???

Answer 44

Long, prodromal phase

Question 45

True or False: A majority of patients with PD have cognitive impairment right away

Answer 45

True

Question 46

Which three structures may be affected first in PD???

Answer 46

1. Olfactory Bulb 2. Enteric NS 3. Medulla - vagus n

Question 47

Failure of voluntary vertical gaze, as well as unexplained falls early in the disease, and an extended neck posture suggests which disease?

Answer 47

Progressive Supranuclear Palsy

Question 48

What distinguishes PD from Progressive Supranuclear Palsy?

Answer 48

The latter has early falls, problems of downward gaze, extended neck posture, tremor uncommon in PSP and PD drugs are less effective in PSP

Question 49

Which distinguishes PD from Multiple System Atrophy?

Answer 49

Symmetric presentation and multi-system involvement

Question 50

How is Lewy Body Disease distinguished from PD?

Answer 50

Early cognitive involvement, symmetric deficits, and less likely to see tremor

Question 51

GPi, SubThN, and ventral intermediate nucleus (VIM) of thalamus all involved in ___ production

Answer 51

tremor

Question 52

True or False: Cerebello – thalamo – cortical circuit involved in amplifying tremor

Answer 52

True

Question 53

Which symptom of PD is best described: Increase in muscle tone manifested as a speed-independent resistance to passive movement A. Spasticity B. Rigidity

Answer 53

B. Rigidity

Question 54

Which cut-muscular reflex is reduced in PD?

Answer 54

I1

Question 55

_____: slowness of movement including "sequence effect" which is a progressive decrease in speed and amplitude of repetitive continuous movements (eg, gait, writing)

Answer 55

Bradykinesia

Question 56

What does bradykinesia look like during a simple discrete movement?

Answer 56

1. Decreased size of the initial agonist burst 2. Movement achieved through a series of small agonist bursts

Question 57

In PD, one can display shorter step length, reduced foot clearance (shuffling) steps due to ____

Answer 57

bradykinesia

Question 58

_____ gait: a consequence of decreasing step length (sequence effect) and increased cadence

Answer 58

Festinating

Question 59

What is the most typical gait dysfunction in patient with advanced PD? A. Festinating Gait B. Freezing C. Bradykinesia

Answer 59

B. Freezing

Question 60

Pedunculopontine nucleus may contribute to which aspect of PD?

Answer 60

Freezing of gait

Question 61

Impairments in ____ postural adjustments and loss of automatic righting and protective (stepping, grabbing) reactive postural control are seen in PD

Answer 61

anticipatory

Question 62

What is the primary therapy for PD?

Answer 62

Levodopa / carbidopa combination to replace dopamine loss

Question 63

True or False: Carbidopa allows for more L-dopa to cross blood- brain barrier

Answer 63

true

Question 64

True of False: There are significant side effects of taking L-dopa long term

Answer 64

True

Question 65

While Levodopa/Carbidopa improve most symptoms of PD, it does not improve ___ as much

Answer 65

balance - only partially useful for freezing of gait and falls

Question 66

DBS is an option for which patients?

Answer 66

1. Those with sporafic PD 2. Those with dyskinesias

Question 67

True or False: Symptoms not responsive to drugs will likely NOT be responsive to DBS

Answer 67

True

Question 68

____ nucleus is a popular target for DBS

Answer 68

Subthalamic