Parkinson's Flashcards
What is lost in PD? What is first seen?
Substantia nigra pars compacta and DA neurons, olfactory bulb, locus ceruleus (greatest loss), nucleus basalis (Meynert - ACh); fMRI loss in posterior putamen
Where is the locus ceruleus? What and where does it project?
Rostral pons PAG, NE to “everywhere”
What are Lewy bodies?
Cytoplasmic inclusions of ubiquitin, alpha-synuclein in SNpc, etc. in PD
What types of lesions cause dysdiadochokinesia?
Pontocerebellum, basal nuclei
Why does PD cause poverty of eye movements?
SNpr not damaged, inhibits SC deep layers, which leads to inhibition of reflexive saccades, also inhibits FEF voluntary saccades.
What are the best predictors of idiopathic PD?
Resting tremor, asymmetrical motor presentation, L-dopa responsiveness
What is secondary parkinsonism?
Caused by antipsychotic Rx DA blockers, MPTP (heroin contaminant, kills DA neurons)
Why is olfactory deficit important in PD?
Required for Dx idiopathic PD, one of earliest deficits in PD and AD, distinguishes from other parkinsonisms
What are neuropsychiatric problems associated with PD?
Delirium with anti-PD drugs, depressed, anxiety, demented (dementia with Lewy bodies), cognitive impairment
What are the most common complications with PD?
Falls, motor fluctuations, dyskinesias, dementia/depression
Why is L-dopa a treatment option for PD?
Can’t use systemic DA because BBB, side effects; tyrosine doesn’t work
What is carbidopa?
AADC blocker inhibits L-dopa conversion to dopamine in blood stream until past BBB
What are problems with L-dopa?
Neural loss still occurs, may worsen, effectiveness gradually decreases, changes in efficacy for no reason, disabling dyskinesias
Why are DA agonists a good or bad idea?
Reduce risk of dyskinesia, may have neuroprotective side effects; hallucinations/psychosis, avoid in elderly or cognitively impaired
What are surgical treatments for medically resistant PD?
Unilateral thalatomy for tremor (VIM nuc for various tremors); neural transplant; DBS of STN, VIM, GPi; unilateral pallidotomy for tremor, bradykinesia
