Parkinson's Disease Flashcards
Parkinson’s disease affects approx. 127,000 people in the UK, and this number…
Is expected to rise with the aging population.
What age category does parkinson’s disease affect?
Mostly affects people over the age of 50.
It is the second most common __________________ disease after Alzheimer’s Disease.
Neurodegenerative.
Typically who’s more affected by PD- Men or Women?
Men.
Parkinson’s Disease symptoms typically present on…
one side of the body initially.
Name another name for parkinson’s disease.
Multisystem disorder.
For parkinson’s disease what is often not straightforward?
Diagnosis is often not straightforward.
What is meant when Parkinson’s Disease is referred to as heterogeneous?
That there is considerable variability seen in terms of symptoms and rate of progression.
aka. it varies, individuals can present differently.
Parkinson’s disease is a ________ disease.
Progressive.
Parkinson’s is a progressive disease, what does this mean?
There is no cure, slowly gets worse.
Symptoms can be managed primarily through medication and therapy- but they can’t halt progression.
James _____________ wrote an essay on ______ __________ in 1817. This was the first medical description of the symptom (although symptoms were described much earlier on.
Parkinson
“Shaking Palsy”
Historically what has been the focus of PD?
The motor symptoms associated with the condition.
Ever increasingly ________ ______________ associated with PD have been acknowledged and researched.
non-motor symptoms
What is the umbrella term that Parkinson’s comes under?
Parkinsonism.
Name the 3 conditions that come under Parkinsonism.
Parkinson’s Disease - most common
Secondary Parkinsonism - drug induced aka. drug use or vascular (mini strokes)
Parkinson’s Plus Syndromes / “atypical variants” - parkinson’s with… multiple system atrophy (MSA), progressive supranuclear palsy (PSP), Corticobasal Degeneration (CBD).
What is the main cause of Parkinson’s Disease?
The vast majority of cases are idopathic (we don’t know the cause).
If you get Parkinson’s Disease at a younger age, what is this known as?
Young onset parkinson’s.
A ______ factor can sometimes cause parkinon’s disease, what is this called?
Genetic.
Familial Parkinson’s Disease.
What is used to diagnose Parkinson’s Disease?
The Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria.
How is PD diagnosis made?
It’s made through individuals’ clinical presentation, physical examination and medical history.
What scan may carried out for diagnosis of PD?
SPECT (single photon emission computed tomography)
A SPECT scan is a type of nuclear imaging test that shows…
how blood flows to tissues and organs.
There is currently no ______ for Parkinson’s Disease.
Test.
A positive response to ______ is suggestive of Parkinson’s Disease.
Levodopa.
What is the criteria for parkinsons?
Bradykinesia with at least one of the following:
- Tremor
- Rigidity
- Postural Instability
What is the tremor that people with PD often show, called?
Pill rolling tremor.
What makes the tremor worse?
stress.
What is bradykinesia?
slow movement.
Define rigidity.
muscle tension/stiffness - the inability of the muscles to relax.
What can often be seen later on in Parkinson’s Disease?
Postural Instability.
What is postural instability?
Changes in balance.
Name some other symptoms of PD.
- Gait disturbance (short, shuffling steps)
- Masked face (reduction in facial expression)- can impact communication
- Dysarthria
- Dysphagia
- Depression
- Anxiety
- Attebtion Deficit
- Sleep disorders
- sensory symptoms eg. Pain
- autonomic symptoms eg. sweating
- gastrointestinal symptoms eg. excess of saliva, reflux/ vomitting
- Fatigue
- Cognitive and Language changes
What happens to symptoms over time?
Existing ones worsen and get new symptoms.
Levodopa drug is good but…
may have side effects over time.
_____________ process which leads to PD begins long before motor symptoms become evident.
Pathological
What are the 3 phases of development of PD?
- Preclinical
- Premotor
- Motor Parkinson’s Disease
What is the preclinical phase?
No clinical symptoms
Pathology assumed to be present but not enough to be noticed.
Define the premotor phase and give some examples.
Where early symptoms (not motor ones) are evident
Olfactory (smell) deficit
Sleep Disorders
Constipation
Mood Changes
The _______________ ______________ ____________ phase is the manifestation of classic motor and non-motor symptoms.
Motor Parkinson’s disease
At the motor parkinson’s disease phase what can be said?
It can be said to be Parkinson’s Disease.
There are no _______ for PD.
Biomarkers.
_________ symptoms have potential use as clinical biomarkers.
Pre-motor
Potential ______, _______ and _____________ biomarkers have been identified.
Neuroimaging
Genetic
Neurochemical
What must be considered about biomarkers tho?
There is no cure and we can’t stop the progression of PD, so is it ethical to tell the patient? what impact will this have on them?
What is thought to be the main cause of Parkinson’s Disease (neuropathology)?
the loss of dopamine producing neurons.
Typically, what is the reduction in dopamine production by the time of diagnosis?
Typically there’s a 70-80% reduction in dopamine production by the time of diagnosis.
Describe the Lewy Body Pathology.
Abnormal aggregrates (clumps) of alpha-synuclein protein- thought to cause PD.
PD is caused by a loss of ______ _______.
Dopaminergic Neurons
What is dopamine?
Dopamine is a neurotransmitter.
How many dopaminergic pathways are there?
There are 4.
In Parkinson’s Disease, where is the loss of dopamine producing neurons most profound?
Within the Substantia Nigra Pars Compacta (SNc)- the origin of the nigrostriatal pathway.
Where does the nigrostriatal pathway project primarily?
The dorsal striatum.
The nigrostriatal pathway also has some projections to the _____ striatum and _______. It has minor projections to the _____ _________ and _______ ___________.
Ventral
Cortex.
Globus Pallidus
Subthalamic Nucleus
What tier of the SNc is mostly affected?
The ventral tier.
Dopaminergic neurons in the ________ ________ ________ (VTA) are also lost but to a much lesser extent.
Ventral Tegmental Area.
Neurons originating at the Ventral Tegmental Area project mainly to the ________ _______ and ________.
Ventral striatum
Cortex
Where does the VTA have few projections to?
The dorsal striatum.
Where are there also some further minor projections from the VTA?
The Globus Pallidus
The Subthalamic Nucleus
What are the Basal Ganglia?
A collection of subcortical, grey matter structures, deep within the brain.
Name the main structures of the basal ganglia.
- Striatum
- Globus Pallidus
- Substantia Nigra (SN)
- Subthalamic Nucleus (STN)
What is the striatum made up of?
- Caudate nucleus
- putamen
- Accumbens nucleus
Name the 2 parts of the globus pallidus.
Internal (GPi)
External (GPe)
Name the two parts of the Substantia Nigra.
Substantia Nigra Pars Reticulata (SNr)
Substantia Nigra Pars Compacta (SNc)
What part of the basal ganglia is really important for dopamine production?
Substantia Nigra Pars Compacta (SNc)
What is the role of the basal ganglia?
- Motor Control
- Learning
- cognitive Functions
- emotions
How does the basal ganglia perform it’s roles?
Through a number of different circuits.
What is Putamen linked with?
Motor control.
What is caudate linked with?
Eye movements and cognitive functions.
_________ ______________ is linked with the limbic system. What is the limbic system responsible for?
Ventral Striatum.
Responsible for emotional behaviour.
What is the main input structure of the basal ganglia?
Mainly the striatum (causdate nucleus, putamen and accumbens nucleus).
Where does the striatum receive projections from (input from)?
- Cerebral Cortex
- Brainstem
- Thalamus
Apart from the striatum, how is input also recieved?
Its also recieved through the subthalamic nucleus.
What are the main output structures of the basal ganglia?
- Globus pallidus internal (GPi)
- Substantia Nigra Pars Reticula (SNr)
Where does the globbus pallidus internal and substantia nigra pars reticula project to initially?
Projects initially to the thalamus and brainstem.
The thalamus projects principally to _________ ________ of the ____________ ___________.
Widespread Areas
Frontal Lobe.
Name the 3 pathways of the basal ganglia (between the input and output structures).
- Direct Pathway
- Indirect Pathway
- Hyperdirect Pathway.
What is the direct pathway’s role?
Facilitation of cortically initiated activity (GO signal).
What is the direct pathway also referred to as?
Go signal.
What is the role of the indirect pathway?
Suppression, braking of cortically initiated activity (NOGO signal).
What is the other name for the NOGO signal?
Indirect pathway.
Describe the direct pathway.
Cortex»_space;» Striatum»_space;» GPi/SNr»» Thalamus
What is different about the indirect pathway?
After going to the cortex»_space;» striatum
The signal goes to the…
GPe»»> Subthalamic Nucleus (STN),
then the GPi/SNr and Thalamus.
What is this pathway?
cortex»_space;» Subthalamic nucleus (STN)»> GPi/SNr»> Thalamus.
Hyperdirect pathway.
What does the hyperdirect pathway miss that the others include?
The striatum.
In the basal ganglia, activity along the pathways is modulated by what?
It’s modulated by Dopamine.
What receptors does the direct pathway have?
D1 receptors
What are D1 receptors and what does activation of the receptors result in?
They are excitatory receptors.
Activation of receptors results in increased activity of the direct pathway.
D1 receptors causes an ______ in activity of the direct pathway.
Increase.
What are the receptors for the indirect pathway?
D2 receptors.
Activation of D2 receptors results in…
Decreased activity of the indirect pathway.
D2 receptors cause a ______ in activity of the ________ pathway.
Decrease
Indirect
What activates D1 and D2 receptors?
Dopamine.
How does a reduction of dopamine affect the pathways?
- Reduction in activation from direct pathway LESS GO
- Increase in inhibition from indirect pathway MORE NO GO
Overall a reduction of dopamine turns down the _____ and turns up the _______.
GO
NO GO
Recent evidence indicates that the direct and indirect pathways may be more intertwined than previously thought, both ____ and __________.
Structurally
Functionally
Name other neurotransmitter systems that are also implicated by Parkinson’s Disease.
- Cholinergic
- Serotonergic
- Adrenergic
- Glutamatergic
- GABAergic
In terms of neurotransmitters, what causes symptoms?
The balance of the neurotransmitters changes = symptoms
Loss of neurotransmitter= symptoms
What part of the brain is thought to be contributing to the clinical symptoms seen in Parkinson’s Disease?
The cerebellum.
There are reciprocal connections between the ________ ________ and the cerebellum.
basal ganglia.
There’s some indication of structural changes in the _______ in PD.
Cerebellum.
What are present in the SNc?
Lewy Bodies and Lewy Neurites.
what can happen with lewy bodies to cause PD?
Abnormal aggregates (clumps) of alpha-synuclein protein form.
It has been proposed by braak that _____ _____ pathology progresses in a predictable pattern, in 6 stages, beginning in structures of the _______________ and ______________.
Lewy Body
lower brainstem
olfactory system
Braak staging has gained some traction but remains ________.
Challenged.
What are the spectrum of lewy body disorders proposed?
Parkinson’s Disease
Dementia with Lewy Bodies
- Hoehn and Yahr - stages 1 to 5
- Pathways Stages (diagnosed, maintenance, complex, palliative)
- Goetz et.al Unified Parkinson’s Disease Rating Scale (50 Q’s about motor and non motor symptoms)
What are these all examples of?
Tools for monitoring progression.
Name 3 ways PD is medically managed.
Dopamine Antagonists (act like dopamine) Levodopa (replaces dopamine) Enzyme Inhibitors (prevents breakdown of dopamine)
What is the bad thing about medication?
There are side effects :(
What is a common side effect from the medication?
Hallucinations.
Why does the medication trigger hallucinations and delusions?
Due to the medication increasing dopamine level.
What side effect can Levodopa induce?
Dyskinesias (involuntary movement)
What is Dyskinesias?
An abnormal, uncontrolled, involuntary movement.
Name the 2 types of movements levodopa induced dyskinesias causes.
- Choreic Movements (abnormal, purposeless involuntary movements)
- Dystonic Movements (muscles tighten, involuntarily sustained contractions)
What are 2 surgical options for PD?
Deep Brain Stimulation
Lesioning Surgery.
If side effects from medication are large, or medication no longer works what can be done?
Deep Brain Stimulation
Explain what DBS is.
electrodes placed on specific brain area and electric impulses sent to the brain :)
Usually the STN or GPi
__________ _________ such as pallidotomy is rarely used nowadays.
Lesioning surgery.
As well as medical management and surgical management, what other management is involved with PD?
Therapeutic management.
Name possible members of the multi-disciplinary team working with someone with parkinson’s disease.
- GP
- Neurologist
- PD Nurse
- Allied Health Proffesionals (OT, PT, SLT)
- Psychiatrist
- psychologist
Why would someone with PD need to see a psychologist/psychiatrist?
Symptoms involve depression, mood changes etc.
In PD what is the most common thing SLTs deal with?
Dysarthria.
What is dysarthria characterised by?
- mono-pitch and mono-loudness
- reduced stress
- imprecise consonants
- short rushes of speech
- variable rate
- harsh and breathy voice
- pitch disturbance
Apart from dysarthria, name the other ares SLTs deal with.
- Language (links with cognitive changes and dysarthria)
- Cognitive abilitis
- other elements eg. masked face (affects the listener)
- Dysphagia
