4a. Parkinson (subcortical dementia) Flashcards
Subcortical dementia in general
Which 3 areas are associated with the cognitive, emotional, and behavioral part of the fronto-subcortical circuits?
- Dorsolateral prefrontal cortex
- Lateral orbital cortex
- Anterior cingulate cortex
Which triad of symptoms are distinguished in PD?
- Bradykinesia = slowing of movements
And at least 1 of:
- Rigidity
- Tremor: during rest, in the extremities or the tongue
What is the characteristic posture of PD patients? (8x)
- Bend forward
- Blank facial expression
3, Slow - Monotonous speech
- Reduced arm swinging
- Rigidiy
- Tremor
- Short, shuffling gait
What are 3 risk factors of PD?
And what is a protective factor?
- Age
- Male gender
- 2 rare dominant mutations and several recessive mutations
Protective: smoking
What are non-motor symptoms in PD? (6x)
- Olfactory dysfunction (early): loss of smell and taste
- Changes in personality and mood: apathy, anxiety, depression
- Sleep: excessive daytime sleepiness & REM sleep behavior disorder
- Autonomic dysfunction: sweating, hypotension
- Psychotic symptoms: visual hallucinations
- Additional: pain, cognitive impairment, dementia
When can we distinguish a definite diagnosis of PD? (2x)
- When post-mortem there is depigmentation of the substantia nigra: in PD there is a loss of the (black) dopamine producing cells > leading to motor dysfunction
- Reacton to levodopa: when a patient reacts on this medication, you know it’s a dopamine problem and thus probably PD
What is the neuropathology of PD?
There are different pathological stages of PD which begins in the brain stem and spreads throughout the brain in 6 stages (low is the olfactory nucleus > that’s why you have loss of taste/smell early on)
Which neurotransmitters are also involved in PD, besides dopamine? (3x)
- (Nor)adrenaline
- Serotonine
- Choline
Explain the ‘dog’ figure in normal people and in PD patients.
Normal: the thalamus is a station that serves as a filter for the cortex. It has an excitatory effect on the (motor)cortex, but it is inhibited by the globus pallidus and substantia nigra, so it’s never too active (=dog on the leech).
PD: loss of dopamine > too much inhibition of the thalamus > loss of excitation to the cortex > lack of motor activity (=dog is doing nothing)
Which 3 clinical subtypes of PD can be distinguished?
- Tremor-dominant: you can see their tremors really easy on the outside, but they have a mild disease progression (not fast and little cognitive complaints
- Akinetic-rigid: they hardly move (more severe cognitive impairment)
- Postural instability & gait difficulty: falling a lot, more severe fom (more cognitive impairment and faster progression)
Which 3 domains are mostly impaired in NPA of PD patients?
- EF: initiation, planning, concept formation, rule finding, set shifting, attention, bradyphrenia (=slowing)
- Memory: retrieval inefficiencies, relative intact recognition (compared to AD)
- Micrographia: abnormally small or cramped handwriting
What are 2 core features of PD-dementia?
- Diagnosis of PD
2. Dementia syndrome (>1 cognitive domain affected, decline from premorbid functioning, and impairment in daily life
What are 2 associated clinical features of PD-dementia?
- Cognitive: fluctuating attention, EF, visuospatial, memory, language is preserved
- Behavior: apathy, delusions, sleepiness, changes in personality/mood
What 2 features give an uncertain diagnosis of PD-dementia (but no exclusion)?
- Co-existence of abnormalities that can cause cognitive impairment
- Time interval of cognitive and motor symptoms are unknown
What 2 features give an impossible reliable diagnosis of PD-dementia?
- Cognitive/behavioral symptoms solely in the context of other conditions (depression/medication)
- Features of possible vascular dementia
