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Neurology Yr2 > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

Parkinson’s disease affects approx. 127,000 people in the UK, and this number…

A

Is expected to rise with the aging population.

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2
Q

What age category does parkinson’s disease affect?

A

Mostly affects people over the age of 50.

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3
Q

It is the second most common __________________ disease after Alzheimer’s Disease.

A

Neurodegenerative.

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4
Q

Typically who’s more affected by PD- Men or Women?

A

Men.

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5
Q

Parkinson’s Disease symptoms typically present on…

A

one side of the body initially.

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6
Q

Name another name for parkinson’s disease.

A

Multisystem disorder.

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7
Q

For parkinson’s disease what is often not straightforward?

A

Diagnosis is often not straightforward.

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8
Q

What is meant when Parkinson’s Disease is referred to as heterogeneous?

A

That there is considerable variability seen in terms of symptoms and rate of progression.
aka. it varies, individuals can present differently.

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9
Q

Parkinson’s disease is a ________ disease.

A

Progressive.

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10
Q

Parkinson’s is a progressive disease, what does this mean?

A

There is no cure, slowly gets worse.

Symptoms can be managed primarily through medication and therapy- but they can’t halt progression.

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11
Q

James _____________ wrote an essay on ______ __________ in 1817. This was the first medical description of the symptom (although symptoms were described much earlier on.

A

Parkinson

“Shaking Palsy”

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12
Q

Historically what has been the focus of PD?

A

The motor symptoms associated with the condition.

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13
Q

Ever increasingly ________ ______________ associated with PD have been acknowledged and researched.

A

non-motor symptoms

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14
Q

What is the umbrella term that Parkinson’s comes under?

A

Parkinsonism.

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15
Q

Name the 3 conditions that come under Parkinsonism.

A

Parkinson’s Disease - most common

Secondary Parkinsonism - drug induced aka. drug use or vascular (mini strokes)

Parkinson’s Plus Syndromes / “atypical variants” - parkinson’s with… multiple system atrophy (MSA), progressive supranuclear palsy (PSP), Corticobasal Degeneration (CBD).

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16
Q

What is the main cause of Parkinson’s Disease?

A

The vast majority of cases are idopathic (we don’t know the cause).

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17
Q

If you get Parkinson’s Disease at a younger age, what is this known as?

A

Young onset parkinson’s.

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18
Q

A ______ factor can sometimes cause parkinon’s disease, what is this called?

A

Genetic.

Familial Parkinson’s Disease.

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19
Q

What is used to diagnose Parkinson’s Disease?

A

The Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria.

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20
Q

How is PD diagnosis made?

A

It’s made through individuals’ clinical presentation, physical examination and medical history.

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21
Q

What scan may carried out for diagnosis of PD?

A

SPECT (single photon emission computed tomography)

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22
Q

A SPECT scan is a type of nuclear imaging test that shows…

A

how blood flows to tissues and organs.

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23
Q

There is currently no ______ for Parkinson’s Disease.

A

Test.

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24
Q

A positive response to ______ is suggestive of Parkinson’s Disease.

A

Levodopa.

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25
Q

What is the criteria for parkinsons?

A

Bradykinesia with at least one of the following:

  • Tremor
  • Rigidity
  • Postural Instability
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26
Q

What is the tremor that people with PD often show, called?

A

Pill rolling tremor.

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27
Q

What makes the tremor worse?

A

stress.

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28
Q

What is bradykinesia?

A

slow movement.

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29
Q

Define rigidity.

A

muscle tension/stiffness - the inability of the muscles to relax.

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30
Q

What can often be seen later on in Parkinson’s Disease?

A

Postural Instability.

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31
Q

What is postural instability?

A

Changes in balance.

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32
Q

Name some other symptoms of PD.

A
  • Gait disturbance (short, shuffling steps)
  • Masked face (reduction in facial expression)- can impact communication
  • Dysarthria
  • Dysphagia
  • Depression
  • Anxiety
  • Attebtion Deficit
  • Sleep disorders
  • sensory symptoms eg. Pain
  • autonomic symptoms eg. sweating
  • gastrointestinal symptoms eg. excess of saliva, reflux/ vomitting
  • Fatigue
  • Cognitive and Language changes
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33
Q

What happens to symptoms over time?

A

Existing ones worsen and get new symptoms.

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34
Q

Levodopa drug is good but…

A

may have side effects over time.

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35
Q

_____________ process which leads to PD begins long before motor symptoms become evident.

A

Pathological

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36
Q

What are the 3 phases of development of PD?

A
  • Preclinical
  • Premotor
  • Motor Parkinson’s Disease
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37
Q

What is the preclinical phase?

A

No clinical symptoms

Pathology assumed to be present but not enough to be noticed.

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38
Q

Define the premotor phase and give some examples.

A

Where early symptoms (not motor ones) are evident

Olfactory (smell) deficit
Sleep Disorders
Constipation
Mood Changes

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39
Q

The _______________ ______________ ____________ phase is the manifestation of classic motor and non-motor symptoms.

A

Motor Parkinson’s disease

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40
Q

At the motor parkinson’s disease phase what can be said?

A

It can be said to be Parkinson’s Disease.

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41
Q

There are no _______ for PD.

A

Biomarkers.

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42
Q

_________ symptoms have potential use as clinical biomarkers.

A

Pre-motor

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43
Q

Potential ______, _______ and _____________ biomarkers have been identified.

A

Neuroimaging
Genetic
Neurochemical

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44
Q

What must be considered about biomarkers tho?

A

There is no cure and we can’t stop the progression of PD, so is it ethical to tell the patient? what impact will this have on them?

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45
Q

What is thought to be the main cause of Parkinson’s Disease (neuropathology)?

A

the loss of dopamine producing neurons.

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46
Q

Typically, what is the reduction in dopamine production by the time of diagnosis?

A

Typically there’s a 70-80% reduction in dopamine production by the time of diagnosis.

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47
Q

Describe the Lewy Body Pathology.

A

Abnormal aggregrates (clumps) of alpha-synuclein protein- thought to cause PD.

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48
Q

PD is caused by a loss of ______ _______.

A

Dopaminergic Neurons

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49
Q

What is dopamine?

A

Dopamine is a neurotransmitter.

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50
Q

How many dopaminergic pathways are there?

A

There are 4.

51
Q

In Parkinson’s Disease, where is the loss of dopamine producing neurons most profound?

A

Within the Substantia Nigra Pars Compacta (SNc)- the origin of the nigrostriatal pathway.

52
Q

Where does the nigrostriatal pathway project primarily?

A

The dorsal striatum.

53
Q

The nigrostriatal pathway also has some projections to the _____ striatum and _______. It has minor projections to the _____ _________ and _______ ___________.

A

Ventral
Cortex.
Globus Pallidus
Subthalamic Nucleus

54
Q

What tier of the SNc is mostly affected?

A

The ventral tier.

55
Q

Dopaminergic neurons in the ________ ________ ________ (VTA) are also lost but to a much lesser extent.

A

Ventral Tegmental Area.

56
Q

Neurons originating at the Ventral Tegmental Area project mainly to the ________ _______ and ________.

A

Ventral striatum

Cortex

57
Q

Where does the VTA have few projections to?

A

The dorsal striatum.

58
Q

Where are there also some further minor projections from the VTA?

A

The Globus Pallidus

The Subthalamic Nucleus

59
Q

What are the Basal Ganglia?

A

A collection of subcortical, grey matter structures, deep within the brain.

60
Q

Name the main structures of the basal ganglia.

A
  • Striatum
  • Globus Pallidus
  • Substantia Nigra (SN)
  • Subthalamic Nucleus (STN)
61
Q

What is the striatum made up of?

A
  • Caudate nucleus
  • putamen
  • Accumbens nucleus
62
Q

Name the 2 parts of the globus pallidus.

A

Internal (GPi)

External (GPe)

63
Q

Name the two parts of the Substantia Nigra.

A

Substantia Nigra Pars Reticulata (SNr)

Substantia Nigra Pars Compacta (SNc)

64
Q

What part of the basal ganglia is really important for dopamine production?

A

Substantia Nigra Pars Compacta (SNc)

65
Q

What is the role of the basal ganglia?

A
  • Motor Control
  • Learning
  • cognitive Functions
  • emotions
66
Q

How does the basal ganglia perform it’s roles?

A

Through a number of different circuits.

67
Q

What is Putamen linked with?

A

Motor control.

68
Q

What is caudate linked with?

A

Eye movements and cognitive functions.

69
Q

_________ ______________ is linked with the limbic system. What is the limbic system responsible for?

A

Ventral Striatum.

Responsible for emotional behaviour.

70
Q

What is the main input structure of the basal ganglia?

A

Mainly the striatum (causdate nucleus, putamen and accumbens nucleus).

71
Q

Where does the striatum receive projections from (input from)?

A
  • Cerebral Cortex
  • Brainstem
  • Thalamus
72
Q

Apart from the striatum, how is input also recieved?

A

Its also recieved through the subthalamic nucleus.

73
Q

What are the main output structures of the basal ganglia?

A
  • Globus pallidus internal (GPi)

- Substantia Nigra Pars Reticula (SNr)

74
Q

Where does the globbus pallidus internal and substantia nigra pars reticula project to initially?

A

Projects initially to the thalamus and brainstem.

75
Q

The thalamus projects principally to _________ ________ of the ____________ ___________.

A

Widespread Areas

Frontal Lobe.

76
Q

Name the 3 pathways of the basal ganglia (between the input and output structures).

A
  • Direct Pathway
  • Indirect Pathway
  • Hyperdirect Pathway.
77
Q

What is the direct pathway’s role?

A

Facilitation of cortically initiated activity (GO signal).

78
Q

What is the direct pathway also referred to as?

A

Go signal.

79
Q

What is the role of the indirect pathway?

A

Suppression, braking of cortically initiated activity (NOGO signal).

80
Q

What is the other name for the NOGO signal?

A

Indirect pathway.

81
Q

Describe the direct pathway.

A

Cortex&raquo_space;» Striatum&raquo_space;» GPi/SNr»» Thalamus

82
Q

What is different about the indirect pathway?

A

After going to the cortex&raquo_space;» striatum
The signal goes to the…
GPe»»> Subthalamic Nucleus (STN),
then the GPi/SNr and Thalamus.

83
Q

What is this pathway?

cortex&raquo_space;» Subthalamic nucleus (STN)»> GPi/SNr»> Thalamus.

A

Hyperdirect pathway.

84
Q

What does the hyperdirect pathway miss that the others include?

A

The striatum.

85
Q

In the basal ganglia, activity along the pathways is modulated by what?

A

It’s modulated by Dopamine.

86
Q

What receptors does the direct pathway have?

A

D1 receptors

87
Q

What are D1 receptors and what does activation of the receptors result in?

A

They are excitatory receptors.

Activation of receptors results in increased activity of the direct pathway.

88
Q

D1 receptors causes an ______ in activity of the direct pathway.

A

Increase.

89
Q

What are the receptors for the indirect pathway?

A

D2 receptors.

90
Q

Activation of D2 receptors results in…

A

Decreased activity of the indirect pathway.

91
Q

D2 receptors cause a ______ in activity of the ________ pathway.

A

Decrease

Indirect

92
Q

What activates D1 and D2 receptors?

A

Dopamine.

93
Q

How does a reduction of dopamine affect the pathways?

A
  • Reduction in activation from direct pathway LESS GO

- Increase in inhibition from indirect pathway MORE NO GO

94
Q

Overall a reduction of dopamine turns down the _____ and turns up the _______.

A

GO

NO GO

95
Q

Recent evidence indicates that the direct and indirect pathways may be more intertwined than previously thought, both ____ and __________.

A

Structurally

Functionally

96
Q

Name other neurotransmitter systems that are also implicated by Parkinson’s Disease.

A
  • Cholinergic
  • Serotonergic
  • Adrenergic
  • Glutamatergic
  • GABAergic
97
Q

In terms of neurotransmitters, what causes symptoms?

A

The balance of the neurotransmitters changes = symptoms

Loss of neurotransmitter= symptoms

98
Q

What part of the brain is thought to be contributing to the clinical symptoms seen in Parkinson’s Disease?

A

The cerebellum.

99
Q

There are reciprocal connections between the ________ ________ and the cerebellum.

A

basal ganglia.

100
Q

There’s some indication of structural changes in the _______ in PD.

A

Cerebellum.

101
Q

What are present in the SNc?

A

Lewy Bodies and Lewy Neurites.

102
Q

what can happen with lewy bodies to cause PD?

A

Abnormal aggregates (clumps) of alpha-synuclein protein form.

103
Q

It has been proposed by braak that _____ _____ pathology progresses in a predictable pattern, in 6 stages, beginning in structures of the _______________ and ______________.

A

Lewy Body
lower brainstem
olfactory system

104
Q

Braak staging has gained some traction but remains ________.

A

Challenged.

105
Q

What are the spectrum of lewy body disorders proposed?

A

Parkinson’s Disease

Dementia with Lewy Bodies

106
Q
  • Hoehn and Yahr - stages 1 to 5
  • Pathways Stages (diagnosed, maintenance, complex, palliative)
  • Goetz et.al Unified Parkinson’s Disease Rating Scale (50 Q’s about motor and non motor symptoms)

What are these all examples of?

A

Tools for monitoring progression.

107
Q

Name 3 ways PD is medically managed.

A 
Dopamine Antagonists (act like dopamine)
Levodopa (replaces dopamine)
Enzyme Inhibitors (prevents breakdown of dopamine)
108
Q

What is the bad thing about medication?

A

There are side effects :(

109
Q

What is a common side effect from the medication?

A

Hallucinations.

110
Q

Why does the medication trigger hallucinations and delusions?

A

Due to the medication increasing dopamine level.

111
Q

What side effect can Levodopa induce?

A

Dyskinesias (involuntary movement)

112
Q

What is Dyskinesias?

A

An abnormal, uncontrolled, involuntary movement.

113
Q

Name the 2 types of movements levodopa induced dyskinesias causes.

A
  • Choreic Movements (abnormal, purposeless involuntary movements)
  • Dystonic Movements (muscles tighten, involuntarily sustained contractions)
114
Q

What are 2 surgical options for PD?

A

Deep Brain Stimulation

Lesioning Surgery.

115
Q

If side effects from medication are large, or medication no longer works what can be done?

A

Deep Brain Stimulation

116
Q

Explain what DBS is.

A

electrodes placed on specific brain area and electric impulses sent to the brain :)
Usually the STN or GPi

117
Q

__________ _________ such as pallidotomy is rarely used nowadays.

A

Lesioning surgery.

118
Q

As well as medical management and surgical management, what other management is involved with PD?

A

Therapeutic management.

119
Q

Name possible members of the multi-disciplinary team working with someone with parkinson’s disease.

A
  • GP
  • Neurologist
  • PD Nurse
  • Allied Health Proffesionals (OT, PT, SLT)
  • Psychiatrist
  • psychologist
120
Q

Why would someone with PD need to see a psychologist/psychiatrist?

A

Symptoms involve depression, mood changes etc.

121
Q

In PD what is the most common thing SLTs deal with?

A

Dysarthria.

122
Q

What is dysarthria characterised by?

A
  • mono-pitch and mono-loudness
  • reduced stress
  • imprecise consonants
  • short rushes of speech
  • variable rate
  • harsh and breathy voice
  • pitch disturbance
123
Q

Apart from dysarthria, name the other ares SLTs deal with.

A
  • Language (links with cognitive changes and dysarthria)
  • Cognitive abilitis
  • other elements eg. masked face (affects the listener)
  • Dysphagia

Neurology Yr2 (9 decks)

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