Ch 21: What disorders belong to the Parkinson spectrum

Question 1

Parkinsonism

Answer 1

hypokinetic-rigid syndrom
collection of motor symptoms that form the core symptom for a group of progressive neurodegenerative disorders classified as the Parkinson spectrum

Question 2

Parkinson: 4 motor symptoms

Answer 2

1. Lack of movement/slowness (akinesia, hypokinesia and bradykinesia)
2. Rigidity (movements are stiff and sometimes jerky)
3. Rest tremor
4. Postural instability

Question 3

Parkinson: non motor symptoms

Answer 3

1. fatigue
2. hyposmia (disturbed sense of smell)
3. autonomic disorders (blood pressure fluctuations, excessive perspiration, constipation, bladder problems, sexual difficulties)
4. sleep disorders
5. affective disorders
6. apathy
7. cognitive impairment
8. impulse control disorders
9. psychoses
10. hallucinations
11. pain

Question 4

Parkinson: diagnostic criteria

Answer 4

brain abnormalities can only be seen in an advanced stage
bradykinesia with one of the following: rigidity, postural instability and/or rest tremor
motor symptoms should subside after taking levodopa
when symptoms start on the left side –> more cognitive problems

Question 5

Parkinson: risk factors

Answer 5

women > men

higher age

Question 6

Parkinson: causes

Answer 6

degeneration of dopamine-producing neurons in the compact part (part of the substantia nigra or SN)
first in the dorsal striatum and then in the ventral striatum and the mesocorticolimbid dopamine system
The substantia nigra is part of the basal ganglia and interacts with the thalamus and the cortex
Reduced dopamine disrupts the entire circuit –> sub thalamic nucleus becomes hyperactive and causes decreased activation of the motor cortex via the thalamus
When half of the dopamine producing neurons have disappeared symptoms start

Question 7

Parkinson: treatment

Answer 7

No treatment, deterioration cannot be slowed down
Levodopa and dopamine agonists suppress motor symptoms
muscle relaxants an pain medication
deep brain stimulation electrode implanted in brain

Question 8

Side effects antiparkinsonian medication

Answer 8

1. confusion
2. delusions
3. sleep attacks
4. psychosis
5. tolerance
6. dyskinesias
7. impulse control problems
8. attention + memory disorders
9. hallucinations
10. dementia

Question 9

Parkinson: cognitive impairments

Answer 9

attention
mental speed
memory
visuospatial deficiencies (later in course of disease)

Question 10

Parkinson: dementia

Answer 10

Most patients eventually develop dementia
mostly in attention and speed
executive impairment
memory problems less severe than in Alzheimers
visual hallucinations are more common

Question 11

Parkinson: mood & behavioral disorders

Answer 11

anxiety
depression: anhedonia + depressed mood 
loss of motivation 
psychotic behavior at advanced stage: delusions and visual hallucinations
impulse control disorders (ICD)