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Neuro > Nora - movement disorders simplified > Flashcards

Nora - movement disorders simplified Flashcards

1
Q

Components of the basal ganglia

A

Striatum

Pallidum

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2
Q

Which structures are functionally related to the basal ganglia?

A

Subthalamic nucleus

Substantia nigra

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3
Q

What is the function of the basal ganglia?

A

Not well understood

But know it has a function in controlling movement via the thalamo-cortical projection

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4
Q

What is the thalamo-cortical projection?

A

Relays the information from the thalamus to the rest of the cortex

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5
Q

Key neurotransmitter of the basal ganglia

A

Dopamine

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6
Q

Characteristic pathological feature of PD

A

Asymmetric loss of dopaminergic neurons

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7
Q

What causes the loss of dopaminergic neurons in PD?

A

Protein accumulation = Lewy bodies

Made from a-synuclein

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8
Q

What structure is shown to be pathological in the F-DOPA scan of PD patients?

A

Striatum

Since the dopaminergic neurons synapse on this structure

Shows up as less bright

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9
Q

Symptoms of a PD patient

A

Stiffness of arm

Tremor

Handwriting problems

Progressive slowing down when carrying out repetitive tasks

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10
Q

Signs of PD

A

Bradykinesia

Cogwheel rigidity

Gait disorder

Rest tremor

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11
Q

What are the disease complications of PD?

A

Loss of gait and balance

Dementia

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12
Q

What does the Braak hypothesis explain?

A

Spreading of pathological Lewy Body aggregates

Staging of PD can be correlated to the specific pattern of spreading

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13
Q

Causes of PD

A

2% - genetic mutations directly linked to the condition (APP, PSEN1/2)

8% - mutations that act as risk factors for developing the condition

90% - idiosyncratic PD

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14
Q

Types of pre-pharmacological treatment

A

Explanation of diagnosis

SALT

Physio- and occupational therapy

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15
Q

Examples of pharmacological treatment of PD

A

L-DOPA

Dopamine agonist

COMT inhibtor

MAO-B inhibitor

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16
Q

What is the goal of pharmaceutical therapies in PD?

A

Raise the dopamine concentrations in the basal ganglia

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17
Q

How is L-DOPA specialised to increase the dopamine in the basal ganglia?

A

It it can cross the BBB

Given with carbidopa to prevent systemic breakdown of L-DOPA to dopamine which can lead to postural hypotension

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18
Q

What do COMT and MAO-B inhibitors do?

A

Inhibits the breakdown of dopamine into its products

Increasing its concentration in the synapse

19
Q

Example of COMT inhibitor

A

Entacapone

20
Q

Example of MAO inhibitor

A

Rasagaline

21
Q

Example of L-DOPA drug

A

Carbidopa

22
Q

Example of Dopamine agonist

A

Apomorphine

23
Q

What are prodromal symptoms?

A

Early symptoms and signs of an illness that precede the characteristic manifestations of the acute, fully developed illness

24
Q

How many dopaminergic neurons are lost before motor symptoms start to present in PD?

A

60%

25
Q

What are the premotor symptoms of PD?

A

Cognitive -> frontal-executive impairment

Affective -> depression, anxiety

Sleep -> REM behaviour disturbance

Autonomic -> constipation

Special senses -> impaired olfaction

26
Q

What are 3 other Parkinsonian conditions?

A

Progressive supranuclear palsy

Multiple system atrophy

Corticobasal degeneration

27
Q

The two defining characteristics of PSP

A

Vertical supranuclear gaze palsy

Tendency to fall

28
Q

Pathological proteins underlying PSP

A

Tau

29
Q

Which neurons are degraded in PSP?

A

Neurons related to walking

30
Q

Which brain areas are affected by PSP?

A

Brain stem

31
Q

Useful clues for PSP diagnosis

A

No or minimal levodopa response

Little blinking

Frontal dementia -> no problem with memory, but planning and behavioural changes

Age > 40

REM sleep behaviour disturbance

32
Q

What is the main characteristic of MSA?

A

Affects the autonomic system

Leads to symptoms like

  • urinary incontinence
  • postural hypotension
33
Q

What part of the brain is affected by MSA?

A

Cerebellum

34
Q

Protein pathology underlying MSA

A

A-synuclein aggregates in glial cells

35
Q

What is the main characteristic of CD?

A

Caused by atrophy of brain areas, rather than protein aggregate formation

36
Q

What part of the brain is affected in CD?

A

Cortex

Basal ganglia

37
Q

Symptoms of CD

A

Asymmetric limb stiffness

Action myoclonus

Limb apraxia

Inability to carry out skilled purposeful movement

38
Q

What distinguishes CD from PD?

A

CD is very asymmetrical

39
Q

What helps differentiate between a Parkinson’s diagnosis and diagnosis of other movement disorders?

A

Scans - F-DOPA uptake

History - peripheral or non-motor symptoms can be conclusive of PD

Treatment - if patients respond to PD therapy, it is conclusive of PD

40
Q

What is the only way to certainly differentiate between Parkinson’s and other movement disorders?

A

Post-mortem biopsies

41
Q

Which pathway has D1 receptors?

A

Direct

42
Q

Which pathway has D2 receptors?

A

Indirect

43
Q

What is the function of the nigrostriatal pathway?

A

Dual, antagonistic effects on the direct and indirect pathway

Stimulates the direct pathway through binding to D1

Inhibits the indirect pathway through binding to D2

Overall, allows the production of movement

44
Q

Where does the nigrostriatal pathway stem from?

A

Substantia nigra pars compacta

Neuro (23 decks)

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