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Flashcards in Parkinson's Disease Deck (17):
1

Name 4 cardinal features of PD. What other features are there?

- Tremor (in hand or finger)
- Bradykinesia (it takes longer for a person to complete a movement)
- Rigidity (no smooth movement)
- Postural Instability (balance problems)
But also:
- Freezing
- Flexion (act of bending due to bent limbs)

2

Define Parkinson's Diseases

A progressive, neurodegenerative (loss of Dopamine neurones in the brain) disease.

3

Where are dopamine neurones found?

Substantia Nigra (in the midbrain)

4

What symptoms are involved in Parkinsonism?

Tremor
Bradikinesia
Rigidity
Posturial instability

5

Define idiopathic.

When cause of disease is unknown

6

Expand on Tremor feature of PD. (7 points)

- Unilateral therefore only affects one side

- Activity dependent/ happens even when resting but more when doing an activity. Essential tremor only occurs with activity.

- Low frequency (4-7HZ) involuntary movement

- Can cause supination or pronation a.k.a pill rolling

- Affects lips, chin, jaw and legs but not the head/neck and voice (unlike essential tremor)

- can get recurring postural tremor

- this is not always a present feature

7

What symptom is said to be the disabling symptom of PD?

bradykinesia

8

Expand on Bradykinesia feature of PD. (5 points)










What are some other things bradykinesia affects?

- disabling feature of Parkinson's
- can cause micrographia (small, cramped handwriting)
- initially affects fine movements
- due to basal ganglia damage; substantia niagra has lack of dopamine neurones
- difficulties with ADL (activities of daily living) such as getting dressed, eating, putting on clothes

- reduced arm swing
- festination gate (quickening and shortening of normal strides)
- hypomimia (blank face) and reduced blinking
- drooling
- slow monotonous speech, low volume

9

What types of rigidity are there?

- Muscular stiffness/ pain
- Cog-wheel rigidity
- Lead pipe rigidity
- Froment's manoeuvre

10

Postural instability includes features such as f_____. The n___ and tr___ are affected when arms are brought forward in front of the body. This occurs early/late in the disease. It is the cause of ___ percent of falls

flexion
neck
trunk
late
38%

11

What is freezing in PD?

- Sudden and transient (< 10 seconds) inability to move
- Not a universal feature (only happens to around 50%)
- can affect legs (mainly), arms and eyelids
- initiated by visual stimuli or anxiety

12

What are some other motor symptoms of PD?

Primitive reflexes:
- glabellar reflex
- palmomental
- applause sign
Bulbar dysfunction
- sialorrhoea
- dysphagia
- hypophonia
- dysarthria

13

What are some non motor symptoms of PD?

- constipation
- headaches
- sexual dysfunction
- sleep disorders
- cognitive and behaviour abnormalities: dementia, anxiety, OCD and hallucinations

14

At what age can you exclude Wilson's disease?

< 40 years

15

If there is a response to Levodopa, can you diagnose with PD?

Yes

16

Direct pathway - tell me about it

- Striatum releases GABA (inhibitory) neurotransmitter to Globus Pallidus internal.
- NORMALLY the GPi would inhibit the Thalamus and so the thalamus would not be able to activate the motor cortex and so no signal would be sent to muscles; thus NO MOVEMENT.
- Since the striatum releases GABA, this inhibits the activity of GPi and so the thalamus is NOT inhibited.
- Thalamus is free to communicate with motor cortex which can send message to muscle; results in movement.

ANOTHER MECHANISM is present involving the Substantia Nigra.
- SN releases Dopamine which binds to the D1 (excitatory) receptors, which are present in the striatum.
- Now, striatum is excited and can release more GABA to the GPi, leading to more inhibition.
- As a result, thalamus may communicate with motor cortex and can allow for movement.

17

What is present in the dopaminergic neurons in the susbtantia nigra of a person with PD?

Lewy body