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D&T2 Exam 1 > Neurodenerative Movement Disorders - Ferguson > Flashcards

Neurodenerative Movement Disorders - Ferguson Flashcards

1
Q

hypokinesia

A

decreased bodily movement

-associated with diseases of basal ganglia

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2
Q

name a prototypical hypokinetic movement

A

Parkinson’s disease

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3
Q

Parkinsonisms

A

diseases which have similar initial presentations to Parkinson’s disease
-but different clinical course and underlying pathology

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4
Q

What part of the brain does Parkinson’s disease impact

A

substantia nigra neurons die prematurely

  • loss of pigmented dopaminergic cells
  • accumulation to Lewy bodies and Lewy Neurites
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5
Q

how does a patient get categorized as idiopathic or primary Parkinson’s disease

A

neurodegeneration in susbtantia nigra and locus coreuleus

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6
Q

what categorizes secondary Parkinson’s disease

A

some clear cause of the Parkinson’s disease

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7
Q

what infections can cause Parkinson’s disease

A

epidemic of encephalitis

Von Economo’s Encephalitis

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8
Q

what toxins can cause Parkinson’s disease

A

carbon monoxide
carbon disulfide
manganese
L-BMAA toxicity

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9
Q

what designer drug can cause Parkinson’s ? what drug was it trying to mimic

A

MPTP byproduct of meperidine (Demerol)

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10
Q

WHAT DIABETIC GASTROPARESIS HAS MANY FEATURES OF NEUROLEPTICS AND CAUSES SECONDARY PARKINSON’S DISEASE

A

Metaclopramide ( Reglan)

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11
Q

what type of prescription drugs cause Parkinson

A

Neuroleptics ( haloperidol/chlorpromazine (throazine))

reserpine ( deplete dopamine)

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12
Q

what is different about acute trauma that induces Parkinsonism

A

may be reversible

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13
Q

what are the clinical features of Parkinson’s disease

A

TRAP

tremor, rigidity, akinesia, postural instability

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14
Q

what type of tremor is found in Parkinson’s disease

A

rest tremor
asymmetric onset
pill rolling or wrist supination/pronation

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15
Q

describe the rigidity of Parkinson’s disease

A

“cogwheeling” : extension and flexion at elbow and wrist common, ratchet-like feeling

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16
Q

what is akinesia

A

loss or impairment of the power of voluntary movement.

“freeze”

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17
Q

what are other signs of Parkinson

A 
gait impairment 
hallucinations (late in disease) 
REM sleep behavior disorder 
dementia 
autonomic dysfunction: constipation, urinary frequency, sweating
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18
Q

what is the gold standard to treat Parkinson

A

Carbidopa/Levodopa (Sinemet)

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19
Q

MAO of Carbidopa/Levodopa

A

crosses BBB and converts to dopamine by ALLA-decarboxylase

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20
Q

what are disadvantages Carbidopa/Levodopa

A

short half life
competes with amino acids in GI and BBB
motor fluctuations

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21
Q

MOA of MAO-B inhibitors

A

selective inhibition of MAO-B enzyme involved in dopamine metabolism

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22
Q

what are drawbacks for MAO-B inhibitors

A

tons of drug interactions

very mild anti-Parkinson drug

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23
Q

MOA of dopamine agonists

A

directly stimulate D2/D1 receptors

24
Q

compare dopamine agonist to Levodopa and MAO-B and Amantadine

A

less efficacious then Levodopa

more efficacious then MAO-B and Amantadine

25
what is drawback for dopamine agonsts
impulsivity sleep attacks restless leg syndrome
26
Amantadine is effective at reducing what
dyskinesia
27
COMT inhibitors MOA
inhibit COMT | slows dopamine breakdown
28
what other drug is given with COMT inhibitors and why
levodopa | prolongs half life
29
when is COMT inhibitor perscribed
advanced PD when patients are experiencing motor flucations
30
what patients are considered for deep brain stimulator
advanced PD not demented symptoms cannot be controlled by medications
31
what symptoms fail to improve from deep brain stimulator
speech cognition postural instability and gait autonomic symptoms ( constipation)
32
Lew Body disease
deposition of abnormal tau proteins throughout subcortical white matter
33
what are clinical motor features of lewy body demenita
Parkinsonian motor features preceding cognitive and psychiatric features
34
what are psychiatric clinical features of Lewy body
varying levels of alertness and attention -excessive daytime drowsiness visual hallucinations
35
what happens to cognition for lewy body dementia
anterograde memory loss executive function deficits visuospatial impairment
36
Normal pressure hydrocephalus
CSF volume increase results in increase subarachnoid space volume -disrupts normal blood flow and positioning and function of subcortical white matter
37
what are motor features of normal pressure hydrocephalus? earliest feature
``` abnormal gait (earliest feature) shuffling gait ```
38
what are cognitive features of normal pressure hydrocephalus
dementia: memory loss
39
what are other clinical features of normal pressure hydrocephalus
urinary incontinence
40
name a hyperkinetic movement disorder
Huntington's disease
41
what is Huntington's disease
neurons in caudate nucleus and putamen undergo degeneration
42
what is the genetic basis for Huntington's disease
CAG repeat encodes polyglutamine tract on N-terminus of protein Huntingtin chromosome 4 worse with generations
43
what is the motor clinical feature of Huntington's disease
initially chorea - then parkinsonian symptoms - advanced: akinetic-rigid syndrome
44
chorea
"dance" | writhing type movements
45
Psychiatric symptoms of Huntington's disease
depression obsessive-compulsive sexual and sleep disorders changes in personalitly
46
MOA of Tetrabenazine
dopamine depleting agent | cause choreaform movements
47
what is a side effect of Tetrabenazine
depression
48
what should be considered to be first-line therapy for depression in Huntington's
Selective serotonin reuptake inhibitors SSRI
49
Is it okay to give antipsychotics to Huntington's patients
yes
50
what gender is more likely to get PD
males
51
what race tends to get PD
Caucasians more than asians and african american
52
after what age is PD prevelent
65
53
what are environmental risk factors for PD
heavy metal toxicity
54
what is the clincial triad for normal pressure hydrocephalus
abnormal gait urinary incontinence Dementia
55
what goes wrong in extraventricular obstructive hyrocephalus
initial event leading to NPH | diminished CSF absorption at the arachnoid villi
56
how do you diagnose normal pressure hydrocephalus
CT or MRI | lumbar puncture with goal of removing large volume of CSF fluid
57
what is the morphology of the brain in Huntington's disease
entire brain atrophy | striking atrophy of caudate nucleus

D&T2 Exam 1 (22 decks)

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