NP: Lecture 8 Motor disorders Flashcards
parkinson spectrum definitie
group of progressive neurodegenerative diseases which involve various motor symptoms (note: ook non-motor symptoms)
heet ook wel: parkinsonism, hyperkinetic-rigid syndrome
etiology of parkinsonism
degeneration of dopamine producing neurons in part of the substantia nigra
waar zijn substantia nigra deel van
basal ganglia
wat doen substantia nigra
interact with thalamus and cortex.
hoeveel van de DA neurons in SA breakdown?
50%, dus een hele hoop
prevalence of pd
7-10 million people worldwide
pd en gender
male meer dan female
Risk of developing PD is twice as high in men than women, but women have a higher mortality rate and faster progression of the disease.
ouder dan 65 jaar is meer risico
oke logisch
kijken naar model classifications van pd
oke
hoe gaat de classification
hypokinetic-rigid syndrome -> parkinsons disease and atypical parkinsonism
parkinsons -> familial and ideopathic
atypical parkinsonism -> 6 types
6 types of atypical parkinsonism
drug induced
vascular parkinsonism
multiple system atrophy
cortico-basal degeneration
lewy body dementia
progressive supranuclear paralysis
2 classifications of parkinsonism
primary: on average more rapid progression
secundary; more limited reaction to specific drugs
Secondary parkinsonism is when symptoms similar to Parkinson disease are caused by certain medicines, a different nervous system disorder, or another illness. Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease.
primary heeft…
shorter survival time
more prominent cognitive detoriation
initial stage: hard to differentiate between the variants.
maar course of disease is crucial!
4 motor symptoms
bradykinesia (= slowness!!!!)
rigidity
rest tremor
motor instability
non-motor symptoms 3
fatigue/sleep disorder
pain
hypnosmia
hoe classificeren van de severity
unified parkinson disease rating scale
hoe bepaal je de stage
hoehn & yahr scale
prevalence of co-occuring physical and mental health conditions is high across the autistic adults life span
oke
bij autisme ook higher prevalence of…
dementia and parkinsonism and PD
wat weten we nog niet over relatie tussen autisme en parkinson
- Related to having an intellectual disability/specific genetic syndromes?
- Related to medication use?
- Is it actually parkinsonism or is similar to what we observe in autistic children?
antwoorden op die vragen
16-33% van de mensen met autisme is positief voor PD. medication geen rol, age of onset is late adulthood.
what does a clinical neuropsychologist do for these ppl
- assess cog. impairment and neuropsychiatric problems
- determining disease progression
- determining impact prevention
hoeveel already have impairments when they are diagnosed
24%
wat meet je vooral tijdens testen voor pd
executive dysfunctions: visuospatial or problem with internal generation automatisms
ook:
attention
reduction of processing speed
problems with processing emotional information
learning new skills is hard
neuropsychiatric problems bij pd
depression
anxiety
apathy
psychosis
impulsivity
sleep disorders
…% of pd patients have at least 1 neuropsychiatric symptom. + waarom?
90%, omdat dit te maken heeft met dopamine levels
prevalence depression bij pd
35-70%
hoeveel hebben formal depressive mood disorder
17%
wat is de differential diagnosis bij depressive symptoms
apathy, MCI, dementia
hoeveel mensen met pd hebben anxiety
40-50%
hoeveel mensen hebben formal anxiety disorder
30%
tijdens welke momenten bij PD -> on of off -> hebben mensen vaak anxiety of depressive symptoms
depressive -> during off
anxiety -> during off or during transition on -> off
en wat voor effect heeft anxiety op motor symptoms
anxiety kan leiden tot meer motor symptoms.
dus is vicieuze cirkel: anxiety <-> motor symptoms/off moments
apathy =
Reduced motivation; reduced targeted behaviour; reduced
interest/emotions
hoeveel mensen problemen met apathy
20-40% in pt without dementia
60% in pt with dementia
differential diagnosis apathy bij PD
fatigue, depression, hypoactive delier, MCI, dementia
PD dementia criteria
o PD diagnosis diagnosed before onset of dementia
o MMSE < 26
o Objectifiable cognitive impairment in 2+ domains that interfere with daily functioning
o Active retrieval impaired, recognition maintained
prevalence van pd dementia
25-30% (After 10-20 years majority dementia)
Asphasia, apraxia, agnosia less prevalent in PD dementia versus other
dementia’s
oke
parkinson meds
levodopa, dopamine antagonists
side effects parkinson meds
nacrolepsy to psychosis, hyperkinetic movements & dyskinesia.
gait=
manier van lopen
wat is een andere treatment voor PD
deep brain stimulation
