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Neuroscience Midterm 2 > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What is Parkinson’s Disease?

A

It is a long-term degenerative disorder of the CNS.

Mainly affects the motor system.

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2
Q

What is the average life expectancy of PD after diagnosis?

A

7-14 years.

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3
Q

Is there a cure for PD?

A

No.

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4
Q

In Canada, how many people are affected by PD every year?

A

1 and every 500 people (6,600 new cases per year).

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5
Q

In 2015, PD affected how many people worldwide?

A

~6.2 million people worldwide and resulted in about 117,400 deaths.

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6
Q

Are women or men more affected by PD?

A

Men.

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7
Q

What age group is affected by PD?

A

Over 60 years.

Prior to 50 years old PD is considered young-onset.

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8
Q

What are the most recognizable symptoms of PD?

A

Tremor
Rigidity
Akinesia
Postural Instability

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9
Q

What is Tremor?

A 
Happens at rest. 
Slow velocity. 
Asymmetrical. 
Tremors may affect chin, jaw, arms, legs. 
30% of PD patients do not show tremor.
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10
Q

What is Rigidity?

A

Increased resistance.
Increased muscle tone and contraction.
Present through the rang of passive movements of a limb.
Can occur in the neck, shoulders, hips, wrists, and ankles.
Occurs in over 90% of patients.

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11
Q

What is Akinesia?

A

Slowness in performing activities of daily living.
Loss of spontaneous movements & gesturing.
Monotonic and hypophonic dysarthia.
Loss of facial expressions (hypomimia) and decreased blinking.
Drooling.
Reducing arm swing while walking.
Present in every single case of PD.

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12
Q

What is Postural Instability?

A

Loss of postural reflexes.
Manifestation of late stage PD.
Can lead to impaired balance and frequent falls.
Most common cause of falls - contributes significantly to risk of hip fractures.

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13
Q

What are the non-motor symptoms of PD?

A

Psychiatric Disturbances
Autonomic Disturbances
Cognitive Impairment
Sleep Disturbances

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14
Q

What are Psychiatric Disturbances?

A

Depression
Anxiety
Apathy

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15
Q

What are Autonomic Disturbances?

A

Constipation
Sexual Dysfunction
Orthostatic Hypotension

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16
Q

What are Cognitive Impairments?

A

Executive function deficit
Dementia
Hallucinations

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17
Q

What are Sleep Disturbances?

A

Insomnia/Fractured Sleep
Narcolepsy
REM behaviour disorder

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18
Q

What structures are in the Basal Ganglia?

A

Dorsal Striatum
Globus Pallidus
Substantia Nigra
Subthalamic Nucleus

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19
Q

What is the Dorsal Striatum?

A

Caudate

Putamen

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20
Q

What is the Globus Pallidus?

A

Externa, GPE.

Interna, GPI.

21
Q

What is the Substantia Nigra?

A

Pars compacta

Pars reticula

22
Q

What does the Basal Ganglia do?

A

It sets the overall tone or motivation for action.

It’s part of a system that focuses actions and picks the correct ones.

Output of BG dictates the likelihood that movements will occur.

BG is organized into loops and speaks to different brain regions, and integrates information.

23
Q

What are the Basal Ganglia loops?

A

Cognitive Loop
Visual/Oculomotor Loop
Affective Loop
Motor Loop

24
Q

What is the Cognitive Loop?

A

Turns on/off gene regions of frontal lobe.

Task switching.

Priority setting.

25
Q

What is the Visual/Oculomotor Loop?

A

Scanning environment.

Spatial recognition.

26
Q

What is the Affective Loop?

A

Emotional component.

Desire, apathy, impulse.

27
Q

What is the Motor Loop?

A

To move or not to move?

Putamen, Globus Pallidus and Substantia Nigra.

28
Q

What happens to the Basal Ganglia in patients with PD?

A

Cell death in the Basal Ganglia -> Substantia Nigra.

Up to 70% of the dopamine secreting neurons are affected.

Leads to dopamine depletion in the SN and the nigrostriatal DA pathway.

Dysfunctional motor loop of the BG.

TRAP.

29
Q

What is the role of Dopamine?

A

The dopamine neurons in the substantia nigra form strong connections with the dorsal striatum, globus pallidus, and the motor cortex.

These are excitatory connections.

Dorsial Striatum has dense expression of dopamine receptors.

Dopamine is the main driver of motor cortex activation.

30
Q

What are other non-motor symptoms of PD?

A

Noradrenergic
Serotonergic
Cholinergic

31
Q

What is Noradrenergic?

A

Urinary frequency

Erectile dysfunction

32
Q

What is Serotonergic?

A

Sleep disturbances

REM behavioural disorder

33
Q

What is Cholinergic?

A

Constipation

34
Q

What causes Parkinson’s Disease?

A

It is idiopathic. No known cause.

35
Q

What are the two causes of cell death?

A

Environmental and Genetic.

36
Q

What are the environmental causes of cell death?

A 
Toxins and/or pollutants 
Head injuries
Infections 
Side effects of drugs 
Injury
37
Q

What are the genetic causes of cell death?

A

Early onset is associated with genetic factors.

15% of individuals with PD have a first-degree relative with the disease.

5-10% of PD cases are known to occur because of mutation in one of several specific genes (SNCA - encodes alpha-synuclein).

Genetic testing for some of the genes is possible, but interpretation is difficult.

38
Q

Who has a reduced risk of Parkinson’s Disease?

A

Individuals who exercise regularly, smoke tobacco, and/or drink coffee or tea.

39
Q

What are the 4 current treatment options for PD?

A
  • Levodopa (L-DOPA)
  • COMT Inhibitors & MAO-B Inhibitors
  • Dopamine Agonists
  • Non-Pharmacological
40
Q

What is the L-DOPA?

A

Precursor to dopamine.

Only 5-10% crosses Blood Brain Barrier.

Temporary improvement in motor symptoms.

Long-term, leads to involuntary movements call dyskinesias, hallucinations, agitation.

Fluctuations occur and patient will cycle through phases with good responses and poor responses to medication.

41
Q

What is are the COMT Inhibitors and MAO-B Inhibitors?

A

Catechol-O-Mehtyltransferase and Monoamine Oxidase B are enzymes that degrades dopamine.

Can be used to compliment L-DOPA in early stages.

Modest symptomatic relief when used alone.

42
Q

What are Dopamine Agonists?

A

Bind to the Dopamine receptors and reduce motor symptoms of PD.

Less effective than L-DOPA, but can be used in early stages.

Side effects include hallucinations, insomnia, nausea, constipation, impulse control issues.

43
Q

What are the non-pharmacological treatments?

A

Education, support, exercise, and nutrition.

44
Q

What are the two surgical options?

A

Deep Brain Stimulation and Stem Cell Treatment.

45
Q

What is the Deep Brain Stimulation?

A

Electrodes are implanted in a target region and they are stimulated with a low-voltage current to facilitate behaviour and reduce medication.

This can help relieve some PD motor-symptoms.

It has been used in treatment of depression, OCD, PD, recovery from TBI and more.

46
Q

What is the Stem Cell Treatment?

A

Healthy Dopamine cells can be plugged into the Substantia Nigra.

Many obstacles in the way before this is a mainstream option.

47
Q

What are Lewy Bodies?

A

Abnormal aggregates of the Alpha-Synuclein protein that develop inside neurons.

Pathologic Alpha-Synuclein acts as a template that corrupts that normal Alpha-Synuclein.

Leads to spherical masses located in the cytoplasm.

Displace other cell components.

They lead to apoptosis of affected neurons - signs of programmed cell death are evident.

48
Q

Can Lewy Bodies be identified under a microscope?

A

Yes.

49
Q

Where can Lewy Bodies be found?

A

Olfactory Bulb
Medulla Oblongata
Pontine Tegmentum

And when the disease progresses:
Substantia Nigra 
Midbrain 
Basal Forebrain 
Neocortex

Neuroscience Midterm 2 (6 decks)

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