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Neuropsychology > Lecture 11: Motor 1: Chapter 21 > Flashcards

Lecture 11: Motor 1: Chapter 21 Flashcards

1
Q

What is parkinson spectrum? What is the most common disease in this spectrum?

A

A group of progressive neurodegenerative diseases which involve various motor symptoms

Parkinson’s disease is most common

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2
Q

What is a different name for parkinson spectrum?

A

Hypokinetic-rigid syndrome

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3
Q

What are 2 types of parkinson spectrum disease?

A
  1. Parkinson’s disease
  2. Atypical Parkinsonism
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4
Q

What are the 2 categories of causes of Parkinson’s disease and how prevalent are they?

A
  1. Familial: 15%
  2. Idiopathic: 85% (unknown cause)
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5
Q

What are 6 types of atypical Parkinson?

A
  1. Drug-induced (secondary)
  2. Vasculary Parkinson (secondary)
  3. Multiple System Atrophy (MSA)
  4. Cortico-basal degeneration (CBD)
  5. Lewy Body dementia (DLB)
  6. Progressive supranuclear paralysis (PSP)
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6
Q

What are the 3 main differences between typical PD and atypical PD?

A
  1. Atypical has more rapid progression, shorter survival time and more prominent and earlier cognitive deterioration
  2. More limited reaction to specific drugs in atypical
  3. In the initial stage of atypical PD it’s hard to differentiate between variants
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7
Q

What is secondary parkinson and which 2 diseases are good examples of that?

A

Parkinsonian symptoms as a result of other abnormalities/damage

Vascular parkinson and drug induced parkinson

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8
Q

What is the prevalence of PD worldwide? How does it differ per gender?

A

7-10 million people worldwide

1,5x more diagnosed in males than females. However it’s more severe in females

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9
Q

Why does the incidence of Parkinson increase? (3)

A
  1. Aging population
  2. Increased life expectancy
  3. Industrialization/pollution
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10
Q

When is the typical onset of Parkinson?

A

50-70, but sometimes also younger

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11
Q

Why is drug-induced parkinson quite different from the other types?

A

Because when the intake of drugs stops, the symptoms often disappear, simply because there is no neurodegeneration.

However, this is not the case if people take these drugs for a very long time.

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12
Q

What is often the first symptom in atypical Parkinson?

A

Cognitive decline, later motor symptoms

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13
Q

What are the 4 motor symptoms of Parkinson and how many should be present to get the diagnosis?

A
  1. Bradykinesia/hypokinesia/
    akinesia
  2. Rigidity
  3. Rest tremor
  4. Postural instability

Symptom 1 must be present + at least one other symptom

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14
Q

What is the difference between akinesia, hypokinesia and bradykinesia?

A

Akinesia: when movement can’t eb started immediately after command

Hypokinesia: decreased bodily movements, limited facial expression

Bradykinesia: slow movements

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15
Q

What is rigidity as a symptom?

A

TIghtness and soreness of muscles. Movements are stiff and jerky, sometimes robot like

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16
Q

What is the cogwheel phenomenon?

A

Stiff and jerky robot like movements in parkinson due to rigidity

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17
Q

What is rest tremor?

A

Tremor present only if the part of the body doesn’t move

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18
Q

What is postural instability? When does this symptom arise in Parkinson? And in atypical Parkinson?

A

Forward bent posture often combined with poor movements resulting in falling.

Arises late in the course of the disease

Atypical: earlier onset

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19
Q

What percentage of people with parkinson report sleep problems? Explain why this can happen

A

70-80%

Causes:
- Medication
- Motor/non-motor symptoms

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20
Q

Why do people with parkinson experience loss of smell (hyposmia)?

A

Because the orbitofrontal cortex, olfactory center, is one of the first regions to deteriorate

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21
Q

What are 4 non-motor symptoms?

A
  1. Fatigue/sleep disorders
  2. Loss of smell/pain
  3. Autonomic disorders
  4. Neuropsychiatric & cognitive impairment
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22
Q

What is dystonia?

A

Persistent muscle contractions

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23
Q

When can you be certain which type of Parkinson it is?

A

Post mortem. Before that you’ll never know for certain, especially not in the beginning

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24
Q

What is a typical symptom of MSA (Muscle system atrophy)?

A

Strongly forward-bent posture and decreased balance, severe speech disorders. These patients are often soon wheelchair dependent

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25
Q

What are typical symptoms of PSP (progressive supranuclear paralysis)?

A

Straight/backbend posture, impairments in eye movements, disinhibition and emotional instability

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26
Q

What are typical symptoms of CBD (cortico-basal degeneration)?

A

Results in cognitive problems (aphasia, apraxia), strong asymmetrical parkinsonism

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27
Q

What is the unified parkinson disease rating scale (UPDRS)?

A

It’s used to establish the severity of parkinson’s disease

28
Q

What are the 5 stages of the Hoehn & Yahr scale (HY)?

A
  1. One side of body affected
  2. Both sides affected, but balance remains
  3. Impaired balance, functioning intact
  4. Walking and standing is difficult without help
  5. Wheelchair-bound or bed-ridden
29
Q

What are the 3 stages in progressive brain degenerations?

A
  1. Preclinical
  2. Prodromal: see difference, but not too much
  3. Clinical: people really need help
30
Q

When is the clinical stage often reached in Parkinson concerning degeneration?

A

When the degeneration reaches the substantia nigra

31
Q

How do SPECT scans work for parkinson?

A

Give patients a tracer that highlights dopamine. Then you can see how many neurons are actually left (less lightening up in parkinsons)

32
Q

What is the main etiology of parkinson’s?

A

Degeneration of dopamine (DA) producing neurons in part of the basal ganglia, especially substantia nigra

33
Q

Which brain regions are always affected in Parkinson’s?

A

Basal ganglia (substantia nigra), which interacts with the thalamus and therefore also with the cortex

34
Q

What percentage of dopamine neurons have to break down in the substantia nigra when parkinsonian symptoms occur?

A

50%

35
Q

What is the function of the substantia nigra?

A

Dopamine production
1. Motivational processes
2. Involved in motor control
3. Cognitive processes

36
Q

What are lewy bodies?

A

Abnormal encapsulations of proteinaceous material in SN and cortex. It spreads to primary cortical areas

37
Q

What is the link between autism and neurodegenerative diseases?

A

People seem more likely to get neurodegenerative diseases when having autism

38
Q

What type of condition is autism?

A

A neurodevelopmental condition

39
Q

What are 2 points of debate concerning perception on autism?

A
  1. Disability instead of disorder
  2. Part of neurodiversity
40
Q

How can you interpret the fact that neurodegenerative diseases are relatively more common in people with autism?

A
  1. Findings might be driven by intellectual disability, not per se autism
  2. Possibly related to medication use
  3. Maybe misdiagnosis due to phenotypic overlap
41
Q

What are 2 phenotypic overlaps between parkinson and autism?

A

Slow movement and stiffness

42
Q

Why is it difficult to determine risk factors for Parkinson disease?

A

Determining the origin of symptoms is hard. E.g. autism and parkinson have overlapping symptoms

43
Q

What are 3 aspects of the role of a clinical neuropsychologist?

A
  1. Assessing cognitive impairment & neuropsychiatric problems
  2. Determining disease progression
  3. Determining impact interventions and their side effects
44
Q

What are the characteristics of the drugs used to treat Parkinson? Make the distinction between treating motor and non-motor symptoms

A

Motor: Often dopamine agonists or drugs that optimize dopamine metabolism

Non-motor: muscle relaxants

45
Q

What are some side effects of Parkinson drugs?

A

Confusion, hallucinations, paranoid delusions and psychosis

46
Q

What are the side effects of dopamine agonists?

A

Impairments in impulse control, sometimes leading to hyperkinesia (too much movement)

47
Q

What is an option when medication in Parkinson doesn’t work anymore?

A

Deep brain stimulation (DBS)

48
Q

What is DBS treatment in parkinson?

A

Implanted electrode that stimulates to a selected cerebral nucleus

49
Q

What is the goal of paramedical care?

A

Ensuring patient remains mobile and independent for as long as possible

50
Q

What type of cognitive dysfunction is related to degeneration of the frontostriatal circuit?

A

Executive impairments

51
Q

What are 5 cognitive problems parkinson patients can have?

A
  1. Executive dysfunctions
  2. Attention problems
  3. Reduction of processing speed
  4. Problems with processing emotional information
  5. Learning new skills
52
Q

What are 6 neuropsychiatric symptoms in parkinson?

A
  1. Depression
  2. Anxiety
  3. Apathy
  4. Psychosis
  5. Impulsivity
  6. Sleep disorders
53
Q

What percentage of PD patients have at least 1 neuropsychiatric symptom? Please elaborate

A

90%

This is high, because all these neuropsychiatric symptoms are also related to dopamine levels

54
Q

Which 2 neuropsychiatric symptoms are seen more often in people with atypical parkinson?

A

Psychosis and impulsivity

55
Q

What are off moments? How is it related to mood?

A

Off moments are times when the DBS is off. This often leads to decreased mood

56
Q

How common is anxiety in Parkinson and how many have a formal anxiety disorder?

A

40-50% have anxiety symptoms

30% have a formal anxiety disorder

57
Q

What is the link between level of anxiety and the amount of motor symptoms in PD?

A

More anxiety is related to more motor symptoms

58
Q

What is the underlying reason why PD patients may develop anxiety?

A

Fear of how others see you (stigma), dopamine deficiency, fear of being a burden to loved ones, fear of the future

59
Q

What is apathy and how often does it occur in people with PD with and without dementia?

A

Reduced motivation and goal-directed behavior

without: 20-40%
with dementia: 60%

60
Q

What is a core characteristic of dementia with lewy bodies that sets it apart from other dementias?

A

More fluctuation in cognitive performance & visual hallucinations

61
Q

What is a main cognitive impairment specific for PD dementia?

A

Active retrieval impaired (recognition intact)

62
Q

Why can’t you leave the DBS on the entire time?

A

DBS has cognitive side effects, such as not feeling like yourself

63
Q

Between what time span does the majority of PD patients develop dementia?

A

After 10-20 years of diagnosis

64
Q

What are the 4 necessities for diagnosing PD dementia?

A
  1. Diagnosis of Parkinson preceding diagnosis of dementia
  2. Cognitive impairments are progressive
  3. Cognitive impairments interfere with daily life
  4. Cognitive impairments present in at least 2 of 4 domains (memory, attention, EF, visuospatial function)
65
Q

Why is there a slight increase in suicide risk after DBS?

A

Possibly because of impairment in impulse inhibition

66
Q

What are the consequences of addiction to anti-parkinson medication?

A
  1. Impulse control disorders
  2. No delayed gratification
  3. Need for sensation with little regard for consequences
  4. Gambling, collecting, compulsive eating

Neuropsychology (16 decks)

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