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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
Q

what is drawback for dopamine agonsts

A

impulsivity
sleep attacks
restless leg syndrome

26
Q

Amantadine is effective at reducing what

A

dyskinesia

27
Q

COMT inhibitors MOA

A

inhibit COMT

slows dopamine breakdown

28
Q

what other drug is given with COMT inhibitors and why

A

levodopa

prolongs half life

29
Q

when is COMT inhibitor perscribed

A

advanced PD when patients are experiencing motor flucations

30
Q

what patients are considered for deep brain stimulator

A

advanced PD
not demented
symptoms cannot be controlled by medications

31
Q

what symptoms fail to improve from deep brain stimulator

A

speech
cognition
postural instability and gait
autonomic symptoms ( constipation)

32
Q

Lew Body disease

A

deposition of abnormal tau proteins throughout subcortical white matter

33
Q

what are clinical motor features of lewy body demenita

A

Parkinsonian motor features preceding cognitive and psychiatric features

34
Q

what are psychiatric clinical features of Lewy body

A

varying levels of alertness and attention
-excessive daytime drowsiness
visual hallucinations

35
Q

what happens to cognition for lewy body dementia

A

anterograde memory loss
executive function deficits
visuospatial impairment

36
Q

Normal pressure hydrocephalus

A

CSF volume increase results in increase subarachnoid space volume
-disrupts normal blood flow and positioning and function of subcortical white matter

37
Q

what are motor features of normal pressure hydrocephalus? earliest feature

A 
abnormal gait (earliest feature)
shuffling gait
38
Q

what are cognitive features of normal pressure hydrocephalus

A

dementia: memory loss

39
Q

what are other clinical features of normal pressure hydrocephalus

A

urinary incontinence

40
Q

name a hyperkinetic movement disorder

A

Huntington’s disease

41
Q

what is Huntington’s disease

A

neurons in caudate nucleus and putamen undergo degeneration

42
Q

what is the genetic basis for Huntington’s disease

A

CAG repeat
encodes polyglutamine tract on N-terminus of protein Huntingtin
chromosome 4
worse with generations

43
Q

what is the motor clinical feature of Huntington’s disease

A

initially chorea

  • then parkinsonian symptoms
  • advanced: akinetic-rigid syndrome
44
Q

chorea

A

“dance”

writhing type movements

45
Q

Psychiatric symptoms of Huntington’s disease

A

depression
obsessive-compulsive
sexual and sleep disorders
changes in personalitly

46
Q

MOA of Tetrabenazine

A

dopamine depleting agent

cause choreaform movements

47
Q

what is a side effect of Tetrabenazine

A

depression

48
Q

what should be considered to be first-line therapy for depression in Huntington’s

A

Selective serotonin reuptake inhibitors SSRI

49
Q

Is it okay to give antipsychotics to Huntington’s patients

A

yes

50
Q

what gender is more likely to get PD

A

males

51
Q

what race tends to get PD

A

Caucasians more than asians and african american

52
Q

after what age is PD prevelent

A

65

53
Q

what are environmental risk factors for PD

A

heavy metal toxicity

54
Q

what is the clincial triad for normal pressure hydrocephalus

A

abnormal gait
urinary incontinence
Dementia

55
Q

what goes wrong in extraventricular obstructive hyrocephalus

A

initial event leading to NPH

diminished CSF absorption at the arachnoid villi

56
Q

how do you diagnose normal pressure hydrocephalus

A

CT or MRI

lumbar puncture with goal of removing large volume of CSF fluid

57
Q

what is the morphology of the brain in Huntington’s disease

A

entire brain atrophy

striking atrophy of caudate nucleus

D&T2 Exam 1 (22 decks)

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