Parkinson, Dementia, Stroke Flashcards
Pyrimidal (Direct) Pathway
-Pathways from the motor cortex to corticobulbar fibers
-Spasticity and paralysis disorders
-Stroke
Extrapyramidal (indirect) Pathway
-Project from the basal ganglia to the brain stem reticular formation
-Involuntary movements, rigidity, and immobility without paralysis Disorders
-Parkinson’s Disease
Parkinson’s Disease
-Progressive destruction of the nigrostriatal pathway and reduction in striatal dopamine.
Know that:
-Dopamine facilitates initiation of movement
-Acetylcholine inhibits initiation of movement
Lewy Bodies
Abnormal aggregate of protein (alpha-Synuclein) that cause degeneration of the nerves that produce dopamine.
-La demencia en la enfermedad Lewy Bodies puede presentarse dentro de un año o menos. Demencia en Parkinson puede tomar más de un año en presenciarse.
Parkinson’s Disease Clinical Manifestation
-Tremor (common)
-Disappears with movement and
sleep
-Rigidity
-Bradykinesia (affects daily tasks)
-Most limiting/debilitating
-Sweating and salivation
-Cognitive Dysfunction
Pathophysiology of PD
Imbalance in neurotransmitters
-Dopamine levels are lower than Acetylcholine (ver foto en ppt)
Target treatment for PD
-Increase dopamine levels
-Stimulate dopamine receptors
-Inhibits breakdown of dopamine
-These three helps with bradykinesia
-Inhibits acetylcholine effect
-Helps with tremors/rigidity
Stroke
-Acute focal neurologic deficit from a vascular disorder that injures the brain tissue
-Leading cause of mortality and morbidity in the US
-Risk factors (smoking, diabetes, heart disease, etc)
Ischemic Stroke (80% prevalence)
-Interruption of blood flow in cerebral vessel by thrombosis or emboli.
-Many types (see other flashcards)
Hemorrhagic (13% prevalence; most fatal)
-Spontaneous Blood vessel rupture cause by hypertension, aneurysm, or arteriovenous malformation.
Infraction core
The tissue that died in the stroke
Penumbra
In a stroke, Cells are asleep but it can be restored.
Thrombotic Stroke (Large Vessel Stroke)
-Most common
-Affects the cortex
-Cause Aphasia (language disorder) and visual field defects
Embolic Stroke (Cardioembolic Stroke)
-Most cerebral emboli originate from a thrombus in the left heart
-Causes Atrial Fibrillation, Rheumatic Heart Disease, MI, ventricular aneurysm, bacterial endocarditis.
Lacunar stroke (Small vessels stroke)
-Small infarcts
-Usually do not cause cortical deficits like aphasia or apraxia (Unable to move when instructed to)
Transient Ischemic Attacks (TIA)
-Minis Strokes sin daños permanentes porque se arreglo antes de que muriera las neuronas.
-Temporary
-There is a high risk of early stroke after a TIA
Stroke-Related motor deficits
-Hay muerte de tejido si ocurre a largo plazo pero no necesariamente de manera aguda.
-Motor deficits are most common.
-Symptom of Babinski sign (flexión de los dedos del pie)
Stroke-Related Dysarthria and Aphasia
-Dysarthria is imperfect articulation of speech sounds
-Aphasia is inability to comprehend, integrate, and express language.
Stroke-Related Cognitive and Other Deficits
-Hemineglect or Hemi-inattention is inability to attend and react to stimuli from the contralateral side (Descuida un lado de su cuerpo)
-Cognitive deficits
-Sensory Deficits
-Visual Disturbances
Acute Ischemic Stroke Treatment Target
Regain blood circulation targeting Clot disruption
Hemorrhagic Stroke Treatment Target
-Since bleeding increases intracranial pressure, treatment is to manage that intracranial pressure.
-Arresting Hemorrhage
-CT scan is necessary to confirm
How to recognize and act with a Stroke? (FAST)
-Face Drooping
-Arm Weakness
-Speech Difficulty
-Time to call 911
What is a Normal Cognitive Aging?
A slow, progressive decline over someone’s life span but does not affect functional abilities.
Neurocognitive Disorders (NCD)
Decline in mental functional severe enough to interfere with a person’s ability to perform daily activities and is not a normal part of the aging process.
-Alzheimer’s Disease
-Parkinson’s Disease
-Lewy Body Disease
-Pick Disease
-Vascular Dementia
Reversible forms of NCD should be ruled out (DEMENTIA)
-Drugs
-Emotional
-Metabolic
-Eyes and ears
-Normal-Pressure Hydrocephalus
-Tumor or other space-occupying lesions
-Infection
-Anemia
Alzheimer’s Disease
Characterized by cortical atrophy and loss of neurons, particularly in the parietal and temporal lobes
-Nuerotransmission disruption, oxidative stress, neuroinflammation, and other factors.
AD Pathology
-Neurofibrillary Tangles
-Amyloid (neuritic) Plaques
-Dense aggregates of AB that are
mutated proteins.
-Decreased cholinergic transmission in the brain
-Disrupted signaling in the cholinergic and glutamatergic systems at the cortex.
AD Clinical presentation
-Loss of Short-term memory
-Difficulty with language
-Changes in behavior
AD Diagnosis
-Autopsy is the only way to truly know the presence of AD
-Clock Drawing Test
Vascular Dementia
Caused by brain injury resulting from ischemic or hemorrhagic damage.
Frontotemporal Dementia (Pick Disease)
Atrophy of frontal and anterior temporal lobes
