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NEUROPSYCH & CLINICAL NEURO > Week 7: Movement disorders > Flashcards

Week 7: Movement disorders Flashcards

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1
Q

What are movement disorders?

A
  • Abnormality in form and velocity of movements

- associated with neuropsychological deficits

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2
Q

Movement disorders have become synonymous with…

A

Basal ganglia disease

  • Not always the origin of causation
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3
Q

Why is it not surprising the movement disorders can have neuropsychological affects?

A

Because the basal ganglia has extensive connectivity

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4
Q

Movement control requires what two systems

A

musculoskeletal and nervous system

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5
Q

What are the 3 stages of movement?

A

Planning, initiation and execution

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6
Q

What areas are involved in the planning of movement?

A

Cerebellum and BG

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7
Q

What areas are involved in the initiation of movement?

A

Motor cortex

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8
Q

What areas are involved in the execution of movement?

A

Alpha motor neurons and the cerebellum for fine-tuning movements

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9
Q

Movement is part of a circuit - explain the highest level?

A

Memory, emotion and motivation - intent to move is formed (command neurons)

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10
Q

Movement is part of a circuit - explain the middle levels

A

Information from the higher level is relayed here

  • postures and movements required determined
  • feedback loops to modulate the activity
  • receive input from receptors in muscles, joints, skin

Creates a motor program, defines what is available to perform the desired task

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11
Q

Movement is part of a circuit - explain the local levels

A

Receptors send messages to the brain stem and spinal cord - motor neurons then send back to muscle fibres

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12
Q

Akinetic-rigid disorders?

A

Akinesia, bradykinesia and hypokinesia

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13
Q

What is Akinesia?

A

Lack of movement

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14
Q

What is bradykinesia?

A

Slow movement - speed of initiation and execution of purposeful and automatic movements

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15
Q

What is hypokinesia?

A

Poverty of movement - small in amplitude

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16
Q

Hyperkinetic disorders?

A

Jerky and non-jerky syndromes

Recognition and diagnosis of these are difficult

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17
Q

What are some of the jerky hyperkinetic disorders?

A

Myoclonus: sudden brief, shock-like involuntary movements.

Chorea: Quick, irregular, semi purposive involuntary movements

Tics: abrupt, jerky, non-rhythmic movements of sounds that are temporarily suppressible by will power. Preceded by a feeling of discomfort or an urge that is relieved by the tic

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18
Q

What are some of the non-jerky hyperkinetic disorders?

A

Tremor: Involuntary, rhythmic muscle contractions and relaxations involving oscillations or twitching movements by 1 or more body parts

Dystonia: abnormal movement, uncontrollable muscle contractions. affected body part twists uncontrollably - repetitive movements or abnormal pressure

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19
Q

What is huntingtons disease?

A

A progressive disorder combining chorea with behavioural disturbances and dementia

Abnormally large repeats of CAG (neucletide sequence) on chromosome 4

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20
Q

Huntingtons is genetic. What is the inheritability rate?

A

50%

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21
Q

Does parkinsons incidence increase with age?

A

Yes

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22
Q

Are there any gender differences in parkinsons?

A

Yes. More common in men

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23
Q

How many parkinsons patients suffer from cognitive deficits?

A

1/3

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24
Q

What did James Parkinson describe parkinsons as?

A

Involuntary tremulous motion, with lessened muscular power. Propensity to bend the trunk forward and to pass from a walking to a running pace, the senses and intellects being uninjured

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25
What is a limitation to the way james parkinson described parkinsons disease?
He did not account for or recognise any cognitive impairments
26
What is parkinsons?
A progressive, degenerative disorder of the central nervous system
27
Is there a cure for parkinsons?
No. There is no way to replace the neurons that die
28
What are the major symptoms of parkinsons?
Bradykinesia | With the presence of at least one of the following: Temor, impaired postural reflexes and rigidity
29
How do those with parkinsons walk?
Slowed gait, feet tend to shuffle along the floor as if weighted down
30
Gross and fine motor skills in parkinsons?
Both are slowed. Handwriting becomes small and imprecise
31
Resting tremor is a symptom of parkinsons - what is it?
Shaking that occurs in relaxed muscles - typically outer extremities such as the hands or feet (e.g. fingers display a regular twitching motion while at rest - pill-rolling tremor) Occurs from activation of opposing muscles that alternated between contraction and relaxation
32
Rigidity is a symptom of parkinsons - what is it?
Increased muscle tension that feels rachet-like when resistance is applied Repeated movements of arm and leg joints result in muscular stiffness, and movements take on a jerky quality
33
What postural deformity is common in parkinsons?
A stooped posture with flexion of the trunk
34
Parkinsons patients have difficulty in swallowing foods and liquids. What is this called?
Dysphagia
35
Slowed or slurred speech is common in later parkinsons why?
Because of a weakness in the muscles used for speech. This is dysarthria
36
Dementia prevalence in parkinsons?
It is a common late feature of idiopathic Parkinsons affecting 70-80%
37
How long after the onset of parkinsons, does dementia occur?
A year or more after
38
What is it when dementia symptoms appear at the same time as motor symptoms?
Dementia with Lewy bodies
39
Does dementia always occur in parkinsons disease?
No.
40
Those with parkinsons dementia have additional struggles with...
Social and occupational functioning
41
What are the biological hallmarks of parkinsons dementia?
Similar to dementia with lewy bodies | - sticky clumps of protein found in neurons
42
What increases the risk of parkinsons dementia?
``` Increasing age Advanced disease stage Being male Having hallucinations Older age at onset of parkinsons Family history of dementia More severe motor symptoms ```
43
What are movement deficits primarily linked to?
Dopamine deficits
44
What percentage of patients with parkinsons have depressive symptoms?
30-40%
45
What percentage of patients with parkinsons have anxiety? and what kinds?
40% | GAD, anxiety attacks, social avoidance and even OCD
46
Psychotic symptoms in parkinsons?
May affect up to 50% May include visual hallucinations and delusional behaviour
47
Explain the parkinsons iceberg
People see some symptoms at the tip of the iceberg - rigidity, tremor, bradykinesia and postural disturbance But what they don't see is what is under the water - speech, panic attacks, swallowing problems lack of facial expression, pain, depression, anxiety, hallucinations, sweating
48
What are the 2 different categories of parkinsons?
Degenerative & symptomatic/secondary
49
What is degenerative parkinsonism?
Sporadic and genetic degenerative diseases cause nigrostriatal neurodegeneration
50
What is symptomatic/secondary parkinsonism?
Caused by non-degenerative lesions of the same system or other sites of the striatopallidothalamic-cortical motor circuitry E.g. infectious, toxic, drug-induced, brain tumours, metabollic
51
The cause of both neurodegenerative and symptomatic parkinsons is
disorders that affect the nigrostriatal dopamine transmission and or downstream signalling pathways
52
What is the basal ganglia?
Brain area comprised of a set of brain structures in the telencephalon, diencephalon and mesencephalon
53
What are the forebrain components of the basal ganglia?
Caudate nucleus, putamen, nucleus accumbens and the globus pallidus
54
Which two regions of the BG are considered the striatum?
The caudate nucleus and the putamen
55
What is the substantia nigra and how does it relate to parkinsons?
``` Part of the BG Contains dopamine neurons 2 parts: - pars compacta - dopaminergic pathway to the striatum - loss of neurons here is the cause of parkinsons - pars reticulata ```
56
What are the two pathways of the BG?
Direct excitatory pathway (dopamine D1): activation of the motor cortex. The accelerator as the direct pathway inhibits the basal ganglia - meaning it doesnt have as much control as it normally does Indirect inhibitory pathway (dopamine D2): inhibition of the motor cortex. is the brakes! excites the basal ganglia and therefore it has its normal control, inhibiting output
57
Which BG pathway do we use?
Both at the same time - in balance
58
What is Levodopa (L-DOPA)?
Most effective symptomatic treatment of parkinsons
59
Problems with L-DOPA?
There are some resistant symptoms: postural abnormalities, freezing episodes and speech impairments (motor), mood and cog impairment (non-motor) Drug related side effects: psychosis, motor fluctuations,
60
Plain L-DOPA produces... and we fix it by....
1. Nausea | 2. Combining with carbidopa to prevent nausea
61
What are dopamine agonists?
Stimulate dopamine receptors directly
62
COMT inhibitors?
Are used in combination with L-DOPA. They black the action of enzymes that break down the drug
63
What are MAO-B inhibitors?
They stop the breakdown of dopamine in the brain - the longer you can keep dopamine available in the brain, the better
64
What are anticholinergics?
Can be helpful for tremor and may ease dystonia associated with wearing-off or peak-dose effect of levodopa
65
What is amantadine?
Antiviral drug used for people who may have developed dyskinesias following long term Levodopa use
66
What surgical technique has been developed to treat severe cases of parkinsons?
Deep brain stimulation
67
How does deep brain stimulation work?
Very thin wire electrodes are inserted through the skull and brain into the subthalamic nucleus A connected wire is inserted into the chest under the skin (pacemaker-like control device) During times of extreme tremor the patient can activate the pacemaker which electrically stimulates the subthalamic nucleus - stops tremor activity
68
Limitations to symptom relief after deep brain stimulation?
while the tremors stop, bradykinesia and rigidity often persist
69
Dangers of deep brain stimulation?
Invasive - low but potentially serious risks of haemorrhaging and infection
70
What else can dep brain stimulation be used for?
MDD, OCD, AD, PD, pain and addiction

NEUROPSYCH & CLINICAL NEURO (12 decks)

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