7: Parkinson's disease Flashcards
Parkinson’s disease becomes symptomatic (early / late) in its course.
late
Which pathway is most responsible for motor function?
Corticospinal tract
Which parts of the brain are responsible for adjusting movement information?
Basal ganglia
What is the role of the cerebellum in movement?
Coordination
What is the difference between Parkinson’s disease and Parkinsonism?
Parkinson’s disease - specific disease process causing symptoms
Parkinsonism - PD-like symptoms caused by other factors e.g dopamine antagonists
Which gait is caused by damage to the cerebellum?
Ataxic gait
What are the five basal ganglia?
Caudate nucleus
Putamen
Globus pallidus
Substantia nigra
Subthalamic nucleus
What is the role of the basal ganglia?
Adjustment of movement impulses
Which neurotransmitters are involved in PD?
Dopamine
Noradrenaline
Acetylcholine
Serotonin
Which basal ganglion degenerates in PD?
Substantial nigra
Which type of neuron is lost from the substantia nigra in PD?
Dopaminergic neuron
What is the hallmark of PD on histology?
Lewy bodies
___ bodies are a hallmark of PD.
Lewy bodies
Where in the brain is the substantia nigra found?
Brainstem
Does PD spread from the substantia nigra?
Yes
___ neurons are lost from the substantia nigra in PD, causing (sensory / motor) symptoms.
Dopaminergic neurons
Motor symptoms
What are the motor symptoms of PD?
Resting tremor
Bradykinesia (slower movements)
Rigidity
Postural instability
Resting tremor in PD is (symmetrical/asymmetrical).
asymmetrical
best seen with hands in the lap
What is bradykinesia?
Reduced speed of movement
What is rigidity?
Increased muscle tone throughout a movement
Like dystonia - produces a stiff, “bent forward” posture
Where do PD patients experience rigidity?
Is it unilateral or bilateral?
Back, neck, limbs
Unilateral in limbs
How do you test postural stability in a patient?
Challenge standing posture
If PD, they will likely fall over
People with PD often have a reduced sense of ___.
smell
Broadly, there are two subtypes of PD: ___-dominant and non-dominant.
tremor dominant
temor non-dominant (emphasis on rigidity, postural instability)
What are some possible non-motor symptoms of Parkinson’s disease?
Associated with DWLB - dementia, hallucinations
Anosmia
Sleep disorders
Describe two types of rigidity seen in Parkinson’s disease.
Lead pipe rigidity - constant resistance to movement throughout a range of motion
Cogwheel rigidity - points of increased / decreased resistance to movement through a range of motion as muscle tension increases and decreases
You need to rule out ___ Parkinsonism or other neurological diseases before diagnosing PD.
secondary
Patients should be tested on drugs affecting which neurotransmitter before being diagnosed with PD?
dopamine
Parkinson’s disease is a diagnosis of ___.
exclusion
What is the biggest risk factor for PD?
Increasing age
PD has a strong ___ component.
genetic
The gene for which protein has been proven to be involved in the formation of Lewy bodies?
Alpha synuclein
Alpha synuclein is a protein found in ___ ___ which is thought to be involved in PD.
Lewy bodies
What are the investigations for PD?
Very few
i.e there aren’t any
How is PD treated?
Dopaminergic treatment
i.e Dopamine agonists, which alleviate motor symptoms
What are the side effects of Dopamine agonists and levodopa?
N&V
Oedema
Increased reward response –> gambling, hypersexuality, risk taking behaviour
Psychosis
Dopaminergic therapy treats the ___ symptoms of PD.
motor
How is the non-motor aspect of PD treated?
Specific therapies for each symptom
