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Neuropathology > Lecture 6: Movement Disorders > Flashcards

Lecture 6: Movement Disorders Flashcards

1
Q

Movement Disorders are going to be PNS or CNS? also include the subsets branches of schematic

A

CNS –> Basal Ganglia, Cerebellum, Cortical Association Areas (cognition/behavior),

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2
Q

Define Movement disorders:

A
  • Conditions that produce inadequate or excessive movement, usually involve impairment of –> Basal Ganglia
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3
Q

Basal Ganglia responsible for?

A

Proper initiation of movement

- relays to the motor cortex (planning, initiation, direct voluntary movement)

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4
Q

Cerebellum responsible for?

A
  • Sensory motor coordination of ongoing movement

- relays to brainstem centers

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5
Q

Name 2 conditions of Hypokinesia

A
  • Parkinson’s Disease

- Atypical Parkinsonian syndromes

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6
Q

3 characteristic symptoms of Hypokinesia?

A
  • Akinesia
  • Bradykinesia
  • Rigidity
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7
Q

name 3 conditions of hyperkinesia

A
  • Essential tremor
  • Huntington’s disease
  • Dystonia
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8
Q

5 characteristic symptoms of hyperkinesia?

A
  • Tremor, chorea, dystonia, myoclonus, tics
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9
Q

Define Rigidity

A
  • stiffness of muscle tone w/ passive movement
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10
Q

Define tremor (hyperkinesia)

A
  • oscillatory, usually rhythmical and regular movement affecting 1 or MORE body parts
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11
Q

Define Dystonia

A
  • Torsional movements –> partially sustained and produce twisting postures
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12
Q

Define Myoclonus

A
  • Sudden involuntary movements usually caused by muscular contractions
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13
Q

Parkinson’s Disease, which gender is more at risk, and what age range?

A
  • 2:1 male to female

- mean age = 56 years

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14
Q

Pathogenesis of PD? @ the cellular level….

A
  • Most cases are sporadic/idiopathic
  • Degeneration of Dopamine producing neurons of SNpc
  • accumulation of Lewy bodies throughout brain
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15
Q

Etiology of PD?

A
  • Genetically: 5-40%

- environemental contributions

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16
Q

Percentage lost of dopamine producing neurons, and DA level?

A

60% of dopaminergic neurons, DA levels decrease at 80%

[symptoms present when individual is at 20% :( ]

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17
Q

hoehn and yahr stages? how many

A

5 stages

1: sx 1 side of body
2: Bilateral sx/ no imbalance
3: impaired postural reflexes
4: severe disability; able to stand or walk
5: W/C bound or bed ridden

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18
Q

Typically progression of PD once diagnosed?

A

2-20 years SLOW PROGRESSION !!!

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19
Q

’ Mild PD’ - year range

A

5-7 years post diagnosis

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20
Q

‘Mild PD’ characteristics

A
  • Movement symptoms - inconvenient, but don’t affect ADLs
  • Changes in posture, walking , facial expression
  • Parkinson’s meds EFFECTIVE
  • Exercise is important
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21
Q

‘Moderate PD’ - year range

A

7-15 years post diagnosis

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22
Q

‘Moderate PD’ characteristics

A
  • Motor fluctuations/dyskinesias

- “freezing episodes occasional

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23
Q

‘Advanced PD’ - year range

A
  • 15-20 years post diagnosis
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24
Q

‘Advanced PD’ - characteristics

A
  • cognitive problems !
  • dual task difficulty: gait and balance
  • Meds less effective
  • Frequent Faller and freezing
  • Dysphagia (swallowing)
  • Autonomic problems: Ortho HTN, constipation
  • Weight loss
25
6 Cardinal Signs of PD
- Bradykinesia - Resting Tremor - Freezing gait - Rigidity - Flexed Posture - Loss of Postural Reflexes
26
3 associated symptoms of PD
- Masked face (hypomimia) - Soft voice (hypophonia) - Small writing (micrographia)
27
Non-motor symptoms of PD
- Cognitive (ONLY LATER NOT EARLY) - sleep disorders - anosmia (can't smell) - fatigue - Bradyphrenia - slow processing of info - Autonomic Dysfunction - neuropsychiatric - anxiety, depression, hallucinations
28
Stage 1/2 PD
- resting tremor NOT imbalance yet
29
Stage 3 PD
- NOW YOU HAVE BALANCE ISSUES/Postural instability | i. e. retropulsion test
30
what is festinating gait?
- shuffling of feet due to turning or within narrow spaces
31
Can you diagnose Parkinson's disease thru clinical diagnosis??
yes --: it is a clinical diagnosis
32
What are the defining characteristics for a PD diagnosis?
- asymmetric onset - gradual onset and gradual progression - 2/6 cardinal signs (one has to be at least resting tremor or bradykinesia)
33
what is the name of the clinical exam for PD?
MDS-UPDRS
34
What can help confirm idiopathic PD? (think meds)
Symptoms improvement with levodopa !!!!
35
What are diagnostic rule out tests for PD?
- MRI (rules out other diagnoses) | - DaTScan mostly used for research
36
Red flags for Parkinson's disease?
- Early Falls (typically seen in stage 3) - Autonomic Dysfunction - Early cognitive symptoms - UMN signs - Cerebellar signs
37
what are the 6 other diagnosis (differential) competing with PD?
- Normal Pressure Hydrocephalus - Drug-induced Parkinsonism - Vascular Parkinsonism - Essential tremor - Wilson's Disease - Atypical PD
38
Essential Tremor is the most common adult-onset movement disorder, more than PD? T or F
- True
39
Pathogenesis of Essential Tremor?
- Neurodegeneration of cerebellum or | - abnormal GABA function
40
What are the tests you look for, for clinical diagnosis of Essential tremor?
- Action tremor of arms (symmetric), head, and voice - Absence of REST TREMOR - ABSENCE OF Parkinonsism or cerebellar signs - >50% are alcohol responsive (removes essential tremor)
41
How can you treat essential tremor? (4 methods)
- Propanolol - Botox - Thalamotomy - DBS (deep brain stim)
42
3 methods of medical mgmt for PD?
- Exercise (preventative, restorative, symptomatic) - Medications (Dopaminergic, nonDA) - Surgical (DBS)
43
Gold standard treatment for PD?
- Levadopa (Ldopa/Carbidopa) --> can go thru BBB --> converts into dopamine
44
Common causes of death/Secondary complications for PD?
- Heart disease, cancer, pneumonia
45
Name a few PT interventions, to medically manage PD:
- Exercise for power/strength, awareness - Dual task training - High intense aerobic training - skill-specific practice
46
What are the 3 Atypical Parkinsonism conditions???
- MSA - multiple systems atrophy - Progressive supranuclear Palsy - Corticobasal Degeneration
47
Is PSP more of a rapid progression than PD?
Yes
48
what is most likely cause of death for PSP? and what is typical prognosis?
- Aspiration due to the dysphagia | - 5-10 years
49
NUMBER 1 Defining characteristic of PSP to differentiate from typical and atypical PD?
- SLOW EYE MOVEMENT/Gaze palsy
50
Name some clinical signs/features of PSP (6)
- Progressive Parkinsonism - Vertical supranuclear ocular palsy - Early onset of Falling - Axial Rigidity - Facial Dystonia - Usually no tremor
51
What are the 3 major system signs of Multiple Systems Atrophy to help with differential?
- PD signs - Autonomic impairments (degeneration of brain stem and medullary autonomic nuclei) - Cerebellar impairments (i.e. mvmt coordination)
52
How many years does it take for PSA to be wheel chair bound?
5 years
53
Mean survival rate of MSA patients?
- 8 -9 years after onset of symptoms
54
what age does CBD typically begin? and is it unilateral or bilateral?
- around age 60s | - typically starts unilateral and then eventually bilateral
55
What is typical cause of death for CBD
- pneumonia, sepsis, pulmonary Embolism
56
3 key features of CBD??
- Parkinsonism - Unilateral arm rigidity and dystonia - cortical sensory deficits (i.e. stereognosis, gravesthesia, extinction
57
other possible symptoms of CBD? (standouts)
- UMN signs - Apraxia - Alien limb phenomenon
58
For atypical Parkinsonism is DBS and LDopa effective?
- No: often not responsive to either
59
Key Identifying characteristics for Atypical PD?
- Early falls, Early cognitive deficits, severe rapid progression of PD symptoms, autonomic involvement, cerebellar impairments - RESPONSIVENESS TO L-DOPA - Vision Impairment

Neuropathology (4 decks)

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