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NeuroMuscular 2 > Basal Ganglia > Flashcards

Basal Ganglia Flashcards

1
Q

Where is dopamine produced?

A

Substantia Nigra

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2
Q

What does the motor loop link?

A

the putamen, globus pallidus, and ventral lateral thalamic nucleus to the motor and premotor cortex

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3
Q

What is the role of the motor loop?

A

movement selection and action, regulating muscle contraction, force, multi-joint movements, and sequencing.

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4
Q

What does the motor circuit regulate?

A
  • Muscle contraction
  • Muscle force
  • Multi -joint movements
  • Sequencing of movements
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5
Q

what is a hypokinetic disorder?

A
  • excessive inhibition

- parkinson’s

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6
Q

what are hyperkinetic disorders

A
  • Huntington’s disease
  • Dystonia
  • Tourette’s disorder
  • Dyskinetic cerebral palsy
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7
Q

Parkinson’s Disease

A

Neurodegenerative disorder of subcortical gray matter in the basal Ganglia
•Dopamine loss in PD = lose inhibitory control of indirect loop and excitatory control over direct loop = decreased movement

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8
Q

Parkinson’s Disease epidemiology

A
  • Occurs throughout ethnic groups, lowest among Asian and African descent, highest incidence among Caucasians
  • More Predominant in males
  • Mean age of onset : Early to mid 60s
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9
Q

Cardinal Signs of PD

A

TRAP
•Tremor(resting)- diminishes with effort, increases with stress/fatigue
•Rigidity- NOT velocity dependent, common in trunk, extremities and neck
•Akinesia/bradykinesia- Correlates best with severity of loss of dopamine
•Postural instability- NOT common early in diagnosis

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10
Q

Movement symptoms of PD

A
  • Tremor
  • Rigidity
  • Bradykinesia
  • Postural instability
  • Micrographia
  • Festinating gait
  • Freezing
  • Soft speech
  • Masked face
  • Sialorrhea and dysphagia
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11
Q

Non-movement symptoms of PD

A
  • Anosmia
  • Anxiety
  • Apathy
  • Bone health
  • Breathing difficulty
  • Cognitive changes
  • Constipation & nausea
  • Dysautonomia
  • Fatigue
  • Hallucinations
  • Pain & sensory disturbances
  • Sleep disorders
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12
Q

Diagnosing PD

A
  • No diagnostic tests
  • based on clinical examination
  • gold standard: neuropathological exam at autopsy
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13
Q

Supportive Criteria for diagnosing PD

A
  • Clear & dramatic response to dopamine therapy
  • Levodopa-induced dyskinesia
  • Resting tremor of a limb
  • Diagnostic testing:
  • loss of olfaction
  • abnormal cardiac MIBG scintigraphy
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14
Q

Negative criteria for diagnosing PD

A
  1. Unequivocal cerebellar abnormalities
  2. Downward vertical supranuclear gaze palsy
  3. Frontotemporal dementia
  4. Parkinsonism restricted to lower limbs >3 years
  5. Treatment with dopamine receptor blocker
    \6. Absence of response to levodopa
  6. Unequivocal cortical sensory loss
  7. Normal functional neuroimaging of dopaminergic system
  8. Documentation of alternative condition known to produce parkinsonism
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15
Q

Prognosis of PD

A
  • progressive and no cure
    •Shift from unilateral to bilateral involvement
    •Increasing rigidity and postural flexion
    •Increasingly limited mobility and increasing need for assistance
    •Eventually w/c and/or bed-bound
    •Cause of death usu. pneumonia
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16
Q

Stage 1 PD

A

Unilateral symptoms-temor, stiffness, slowed movement

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17
Q

Stage 1.5 PD

A

Unilateral symptoms plus axial involvement_ postural problems

18
Q

Stage 2 PD

A

Bilateral involvement and minor sxs: swallow, talk, and decrease in facial expression

19
Q

Stage 2.5 PD

A

Bilateral involvement: recovers on pull test

20
Q

Stage 3 PD

A

Bilateral Involvement worsened. Postural instability noticed. Person is still independent

21
Q

Stage 4 PD

A

Severe disability, able to walk or stand unassisted, but will need help with AD L

22
Q

Stage 5 PD

A

Person is confined to w/c or bed, needs total assistance

23
Q

Early presentation of PD

A
  • Tremor
  • Micrographia
  • Slowness with ADL’s
  • Voice changes
  • Difficulty maneuvering in bed
  • Lack of arm swing with gait
  • Dragging the foot with walking
24
Q

After 5 years of PD

A
  • Motor Fluctuations
  • Wearing off
  • On-off phenomena
  • Narrowing therapeutic window
  • Loss of postural control; retropulsion
  • Gait freezing and Festination
  • Cognitive Changes
  • Medication side effects: dyskinesia, dystonia
25
Q

Medical management of PD

A
  • Primary objective is to maximize control over the “target” signs and symptoms.
  • select the appropriate drug(s) for each symptom
  • adjust dose and frequency of drug administration over time

•The patient’s therapeutic response to any individual drug may change over time and requires regular visits and frequent communication between the medical team, the patient, and caregiver(s) to maintain the best management of the disease with the fewest side effects possible.

26
Q

Carbidopa/levodopa (Sinemet)

A

Most effective; prolongs capacity to perform iADLs

27
Q

Dopamine agonists (Mirapex, Requip)

A

Work by copying actions of dopamine in the brain

28
Q

COMT inhibitors

A

inhibits enzyme responsible for metabolism of levodopa

29
Q

MAO inhibitors (Eldepryl)

A

slow the metabolism of dopamine

30
Q

Anticholinergic agents (Cogentin)

A

used for treatment of tremor in younger pts

31
Q

Deep brain stimulation of PD

A
  • used in advanced PD

- surgical implantation of electrodes into brain

32
Q

What should be tested with ROM in PD?

A
  • rigidity
  • posture assessment
  • limited cervical and trunk rotation
  • hip flexor tightness
33
Q

Strength in PD

A
  • should be wnl

- 5x sit to stand: > 16 sec is correlated w fall risk

34
Q

Coordination in PD

A
  • Movements bradykinetic, small, fatigue with repetition
  • NO dysmetria
  • Dyskinesias
35
Q

Pain in PD

A
  • msk

- central neuropathic

36
Q

Oculomotor and visual in PD

A
  • Visuoperceptual deficits
  • Abnormalities ATYPICAL in early stages of idiopathic PD
  • Impaired/bradykinetic saccades in late stages
37
Q

is there olfactory disturbance in PD?

A

Yes

38
Q

Proprioception in PD

A
  • Decreased sensory integration:

* joint position sense, postural orientation

39
Q

Kinesthetic awareness in PD

A
  • decreased

•larger limb displacement required in order to detect movement

40
Q

Cognition in PD

A
  • Dementia: Planning, Decision-making, Goal-directed behavior
  • Strong correlation between attention and the ‘pace’ domain of gait
  • Gait velocity, step length, and step time
  • Associations with gait variability and executive dysfunction
41
Q

MOCA scoring

A

<26= mild cognitive impairment

< 21= PD dementia

NeuroMuscular 2 (1 decks)

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