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Pathophysiology: Part 2 > 7) Parkinsons > Flashcards

7) Parkinsons Flashcards

1
Q

What are the 4 main characteristics of Parkinson’s?

A

Asymmetrical resting tremor
Bradtkinesia
Rigidity
Postural instability

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2
Q

Parkinson’s affects 1 in 100 people over the age of what?

A

65, more than the combined incidence of MS, ALS and muscular dystrophy

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3
Q

It affects what gender more?

A

2 males: 1 female

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4
Q

What two bad habits is the development of Parkinson’s inversely correlated to?

A

Smoking

Caffeine consumption

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5
Q

What is the general describer of Parkinson’s?

A

Idiopathic, neurodegenerative caused by the loss of dopaminergic neurons in the substantia nigra

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6
Q

Describe synaptic transmission.

A

An influx of sodium causing depolarization produces an action potential that propagates to the presynaptic terminal where it opens Ca channels.
The Ca influx causes the exocytosis of neurotransmitters, which enter the synaptic cleft binding to the post synaptic membrane.

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7
Q

Tyrosine is taken up by the brains extracellularly fluid in the dopaminergic substantia nigra neurons. What two forms does it take on?

A

Tyrosine is hydroxylated to become L-Dopa

L-DOPA is decarboxylated to become dopamine

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8
Q

What part of the brain controls movements?

A

Basal ganglia

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9
Q

What is the basal ganglia composed of?

A

Substantia nigra
Striatum
Subthalamic nucleus

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10
Q

Input from all over the brain is sent through dopaminergic neurons where?

A

Striatum

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11
Q

What is the striatum composed of?

A

Putamen

Caudate nucleus

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12
Q

This part of the striatum has D1 and D2 neuron receptors.

A

Putamen neurons

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13
Q

What does the ventrolateral thalamus do?

A

Initiates body movement.

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14
Q

The sub thalamic nucleus is inhibitory in the motor pathway, what does it connect?

A

Striatum and VLT

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15
Q

The 3 main neurotransmitters in Parkinson’s disease are:

A

Dopamine (excitatory)
GABA (inhibitory)
Acetylcholine (inhibitory)

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16
Q

How does dopamine work?

A

Through the direct and indirect pathway in the basal ganglia to initiate voluntary movement.

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17
Q

When does Parkinson’s manifest itself in relation to dopamine biosynthesis?

A

When ~80% of dopamine function has been lost.

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18
Q

What does too much acetylcholine cause?

A

The antagonistic neurotransmitter causes over activity of cholinergic neurons, leading to muscle contractions that won’t repolarize.

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19
Q

This neurotransmitter is the main inhibitory neurotransmitter.

A

GABA

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20
Q

What is the normal release of GABA regulated by and what will a reduction in the regulator cause?

A

It is regulated by binding to dopamine receptors and a reduction in dopamine causes an increase in GABA, resulting in full or partial paralysis.

21
Q

What stimulates dopamine synthesis?

A

Substantia nigra

22
Q

Dopamine binds to what to receptors on the putamen neurons in the striatum?

A

D1 (direct pathway) and D2 (indirect pathway)

23
Q

Dopamine binding to the D1 receptors of Substance P producing putamen neurons causes an increase in what neurotransmitter and what’s its affect?

A

GABA is increased which inhibit the neuron firing of D1 putamen neurons.

24
Q

D1 putamen neuron firing inhibits what, and when an increase of GABA occurs inhibiting D1 firing what is the result?

A

VLT

Increase of GABA, Decrease in D1 firing= less inhibition of VLT= signals sent to motor cortices leading to movement.

25
Q

Both direct and indirect pathways produce movement by decreasing the inhibition of what?

A

VLT

26
Q

Describe the direct pathway of Parkinson’s.

A

A deficiency in dopamine leads to inactivated D1 receptors, therefore substance P is not released leading to a decrease in GABA.
D1 firing is increased which release GABA inhibiting the VLT to send signal to the motor cortex.
=inability to move

27
Q

This Parkinson’s is characterized by a degeneration of pigmented dopaminergic neurons in the Substantia Nigra, with the remaining dopaminergic neurons containing Lewy Bodies.

A

Idiopathic Parkinson’s Disease

Primary Parkinson’s

28
Q

What are the two possible factors in developing Parkinson’s?

A

Genetics
Oxidative stress
Excitotoxicity

29
Q

The Substantia nigra is a region characterized by high levels of oxidative stress, which means what?

A

The free radicals generated by dopamine metabolism attacks and damage neurons because the normal antioxidants are not there

30
Q

Secondary parkinsonism signs may be due to what 3 issues?

A

Inability for dopamine to be produced, secreted or bind to the post synaptic putamen receptors.

31
Q

What are the 4 causes of secondary Parkinson’s?

A

Drugs
Toxins
Infection
Head trauma

32
Q

The onset of this secondary Parkinson’s is abrupt and symmetrical, caused by dopamine antagonists blocking the dopamine receptors

A

Drug induced Parkinsonism

Antipsychotics and Ca channel blockers

33
Q

Pesticides and heavy metals can cause irreversible damage to the dopaminergic ions in the substantia nigra

A

Toxin induced Parkinson’s

34
Q

The degeneration of nerve cells in the substantia nigra following encephalitis, leaving the patient speechless and statue like

A

Post-encephalitic syndrome

Infection

35
Q

Lesions to the substantia nigra cause hematoma, creating pressure and obstructing ventricular outflow affecting the dopaminergic cells.

A

Trauma induced

Head trauma

36
Q

What is the threshold for clinically detectable Parkinson’s?

A

70-80% of the dopaminergic neurons in the substantia nigra have been lost

37
Q

This primary symptom is common in 2/3 of patients, normally starting unilaterally and becoming bilateral, with severity and amplitude increasing under stress

A

Resting tremor

38
Q

Slowness and discontinuous movement, with freezing in place occurring.

A

Bradykinesia

39
Q

Increased rigidity in passive movement, that begins unilaterally and develops into bilateral

A

Cogwheel rigidity

40
Q

A stooped posture that increases the risk of falling, found in the more advanced stages of Parkinson’s

A

Postural instability

41
Q

What are the two types of secondary symptoms a person may experience?

A

Motor

Autonomic

42
Q

What are the results of motor symptoms.

A 
○Decrease in spontaneous blink rate
○ Hypomimia (no facial expression)
○ Monotonous voice
○ Speech hurried, slurred
○ Micrographia (tiny writing)
○ Drooling
43
Q

What are the results of the autonomic symptoms?

A 
○ Uncontrolled sweating
○ Excess salivation (drooling)
○ Lacrimation (crying)
○ Impaired thermal regulation
○ Constipation
○ Urinary incontinence
○ Impotence
○ Sexual dysfunction
44
Q

What are 5 psychological symptoms experienced with Parkinsons?

A 
Dementia
Anxiety
Depression
Psychosis
Sleep disturbances
45
Q

Describe Huntington’s disease?

A

It is an autosomal dominant neurodegenerative condition that causes hyperkinetic movement, with the age of onset between 30-50 years

46
Q

How is diagnosing for Parkinson’s done?

A

There is no diagnostic test as of yet.

It is done by medical examination and a full clinical history to rule out secondary Parkinsonism.

47
Q

Clinically probable IPD can be diagnosed
when the patient shows 2 of the following
symptoms:

A

● Muscle rigidity
● Bradykinesia
● Resting tremor
● Postural instability

48
Q

The only true confirmation of Parkinson’s comes after death. Why?

A

Autopsy reveals presence of Lewy bodies in

the Substantia Nigra

Pathophysiology: Part 2 (7 decks)

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