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Geriatrics/Neuro > Movement Disorders - Balaguera > Flashcards

Movement Disorders - Balaguera Flashcards

1
Q

what is the basal ganglia?

A

collection of nuclear masses (clustered of neurons) w/in the cerebral hemisphere

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2
Q

what are the 3 functions of the basal ganglia?

A

(1) help to control movement
(2) help to regulate emotion
(3) help to regulate cognitive skills

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3
Q

movement d/o’s come the malfunction of the….

A

basal ganglia

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4
Q

what are the 2 pathways that the basal ganglia controls movement by?

A

direct and indirect pathways

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5
Q

how does the basal ganglia control movement by the direct pathway?

A

increases muscle movement by decreased inhibition of the thalamus

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6
Q

how does the basal ganglia control movement by the indirect pathway?

A

decreases muscle movement via signaling from the thalamus

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7
Q

3 main parts of the basal ganglia?

A

caudate, nucleus accumbent, striatum

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8
Q

if pathology of the caudate part of the basal ganglia, what occurs?

A

OCD

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9
Q

if pathology of the nucleus accumbens part of the basal ganglia, what occurs?

A

depression

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10
Q

what part of the basal ganglia regulate memory of skills and habits like driving a car?

A

the striatum

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11
Q

if damage to the striatum of the basal ganglia, what occurs? what does this lead to?

A

people lose the ability for the skills they had in the past

leads to dementia, depression, agitation (40% of pts with PD have dementia)

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12
Q

what is Parkinsonism?

A

generic terms use to define syndrome that manifests as:

(1) rigidity
(2) resting tremor
(3) bradykinesia
(4) postural inhibition

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13
Q

what is primary Parkinsonism?

A

parkinson’s disease

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14
Q

what is secondary Parkinsonism?

A

vascular or drug-induced

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15
Q

Parkinsonism is hypokinetic or hyperkinetic movement?

A

hypokinetic (very slow)

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16
Q

Huntington’s disease is hypokinetic or hyperkinetic movement?

A

hyperkinetic (very fast)

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17
Q

what are hyperkinetic movements?

A

tremor, dystonia, chorea, cerebellar ataxia, myoclonus

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18
Q

what is a tremor?

A

rhythmic oscillation of a body part

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19
Q

what is dystonia?

A

sustained contraction of agonist and antagonist muscles

opposition tremor, have jerk movement, not oscillatory or rhythmic

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20
Q

what is chorea? what disease is it seen in?

A

brief, irregular, EXPLOSIVE non-rhythmical movements

seen in Huntington’s

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21
Q

what is cerebellar ataxia?

A

impaired initiation and coordination of movements

mainly walking (extremities and gait), also speech

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22
Q

what is myoclonus?

A

lightning-like jerking movements, fast but not as elaborated or explosive as HD

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23
Q

what are the motor sx’s of PD? what parts of body are most frequently affected?

A

resting tremors

hands, fingers, forearms and feet most frequently affected

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24
Q

what are the nonmotor sx’s of PD?

A

hyposmia, speech and voice d/o’s

***dysautonomia, dementia, depression/psychosis

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25
Q

what is dysautonomia?

A

when HR doesn’t change when the BP changes

seen in PD

HTN laying down and dropping BP so much when standing up that pt passes out (orthostatic hypotension)

26
Q

what do you NOT treat dysautonomia with?

A

anti-HTN meds

27
Q

what is the cardinal motor feature of PD?

A

bradykinesia

28
Q

pts with PD must have at least one of the following…

A

4-6 Hz resting tremor, muscular rigidity, postural instability (late presentation)

29
Q

in PD there must be absence of a ___

A

secondary cause

30
Q

pts with PD must have at least 3 supportive criteria…

A
  • Unilateral onset, progressive, resting tremor w/ persistent asymmetry
  • Excellent response to levodopa
  • Severe levodopa induced chorea
  • Levodopa response for >5 yrs
  • Clinical course of >10 yrs
31
Q

what is the most effective tx for PD?

A

levodopa + dopa decarboxylase inhibitor

32
Q

what tx for PD is effective in improving motor fxn and tx of depression?

A

subthalamic deep-brain stimulation

33
Q

PD is a loss of?

A

DA neurons

34
Q

what is vascular secondary Parkinsonism?

A

Microvascular changes and small infarcts from atherosclerosis may disrupt the basal ganglia → parkinsonian s/s w/o degeneration of DA neurons

35
Q

vascular secondary Parkinsonism pts present early with what sx’s?

A

gait problems or marked postural tremor

36
Q

what are the vascular Parkinsonism RF’s?

A

typical vascular RF’s

-HTN, DM, hyperlipidemia, smoking, older age

37
Q

what is the tx for vascular Parkinsonism?

A

PT

38
Q

what is the MAIN drug that causes drug induced Parkinsonism? others?

A

Haloperidol

others: Thioridazine, Perphenazine, Antiemetics

39
Q

what sx’s does drug induced Parkinsonism typically produce vs PD?

A

BILATERAL EQUAL BRADYKINESIA (PD starts unilateral)

40
Q

is drug induced Parkinsonism reversible or irreversible?

A

irreversible

41
Q

how can you tell vascular secondary Parkinsonism from primary PD?

A

because PD responds to Leva-Dopa whereas vascular dz doesn’t

42
Q

what is Huntington’s?

A

Hereditary d/o of the basal ganglia caused by a mutation in one gene in chromosome 4

43
Q

presentation of HD?

A

Progressive motor incoordination, abnormal movements, and intellectual decline

***CHOREA - powerful, forceful movements (can get rhabdo)

44
Q

HD is associated with what disorders? high rates of what with HD?

A

dementia, depression, OCD

HIGH RATES OF SUICIDES

45
Q

what is the ONLY FDA approved drug for HD and what is it’s indication and MOA?

A

Tetrabenazine

Indication: control chorea

MOA: monoamine depleting agent

46
Q

what can you use in HD to control chorea and behavioral comorbidities?

A

antidepressants

47
Q

what other drugs may be used to decrease chorea?

A

amantadine and nabilone

48
Q

what are some complications of HD?

A

dementia

ARF 2/2 rhabdomyolysis - use IVF and early dx to treat

Aspiration PNA

49
Q

what is the M/C movement d/o?

A

essential tremor

50
Q

what is the mean age of onset of essential tremor?

A

45 y/o

51
Q

how does the essential tremor usually start?

A

bilaterally from hands or forearms

52
Q

essential tremor can be what?

A

postural (occurring w/outstretched arms) or kinetic (occurring w/initiating movement)

53
Q

during what actions does essential tremor occur?

A
  • Finger to nose mvmt
  • Pouring and drinking water from a cup
  • Writing
  • Drawing archimedean spirals
54
Q

what’s the KEY DIFFERENCE b/w essential tremor and tremor in PD?

A

PD tremor is resting

essential tremor occurs with action

55
Q

can essential tremor cause cognitive impairments?

A

NO!!!

56
Q

is essential tremor related to alcoholism?

A

NO!!!

57
Q

what is NOT seen in essential tremor, but is seen in PD?

A

NO GAIT abnormalities, NO SPEECH abnl (dysarthria), NOT a/w DEPRESSION

58
Q

what’s the core criteria to dx essential tremor?

A
  • Postural or kinetic tremor of the hands and forearms or at least 1 hand
  • Head tremor w/ no signs of dystonia
  • Absence of other etiologic factors and neuro signs → meds, ETOH, parkinsonism, dystonia, hyperthyroidism
59
Q

what’s the additional dx criteria for essential tremor?

A
  • bilateral
  • duration >1 year
  • severity (interferes w/ ADLs like writing, vocalization)
60
Q

what is the recommended initial tx for essential tremor?

A

Propranolol or primidone (alone or in combo)

61
Q

if essential tremor is refractory, then what’s the tx?

A

deep brain stimulation of the thalamus and unilateral thalamotomy

Geriatrics/Neuro (11 decks)

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