PD

Question 1

Striatum Lentiform Nucleus

Answer 1

Striatum = caudate and putamen LN = GP and putamen

Question 2

Communication of motor planning areas:

Answer 2

Cerebral cortex - thalamus - pedunculopontine nucleus - LMN

Question 3

GABA, Glutamate, and Dopamine (I or E)

Answer 3

GABA - Glutamate + Dopamine -+

Question 4

Percentage of dopaminergic neuro loss before sxs present:

Answer 4

60-80%

Question 5

Epidemiology: Age, ethnicity, and sex

Answer 5

Age - peak onset is 60 Ethnicity - Caucasians > African Americans Sex - Males > females

Question 6

Percentages of sporadic vs genetic PD

Answer 6

Sporadic - 90% Genetic - 10%

Question 7

Etiology of sporadic PD

Answer 7

Oxidative stress Mitochondrial malfunction Inadequate neurotrophic factors Inflammatory glia

Question 8

Occupations factors in PD

Answer 8

Pesticides, herbicides, heavy metals

Question 9

Tobacco, coffee, alcohol factors in PD

Answer 9

Smoking - inverse Coffee - inverse Alcohol - possible inverse

Question 10

Dietary factors in PD - Antioxidants, unsaturated fatty acids, dairy, dietary iron

Answer 10

A - may neutralize free radicles U - inverse Milk - positive Iron - possible positive, inconsistent

Question 11

Causative genes for PD

Answer 11

Atypical presentation - young onset (<50), dystopia, early dementia

Question 12

Susceptibility genes of PD

Answer 12

Complex interaction of environment and genetic factors

Question 13

Cardinal signs

Answer 13

Tremor Rigidity Bradykinesia Poor posture

Question 14

Tremor

Answer 14

Begins unilaterally, present in 70% of time

Question 15

Rigidity

Answer 15

Initially affects proximal musculature and extends dismally

Question 16

Aminesia/bradykinesia

Answer 16

A - loss of movement B - slowness of movement

Question 17

Dystopia

Answer 17

Repetitive movements and spasms - common in toes/foot

Question 18

Hypomima

Answer 18

Masked face

Question 19

Non-motor symptoms

Answer 19

Sleep disturbances Mood disorders (depression) Dysautonomia (OH) Constipation *Typically proceeds motor symptoms by years

Question 20

Dementia

Answer 20

Common in the later stages of PD

Question 21

Dementia with Lewy bodies

Answer 21

• Progressive dementia with impairments in attention and executive function - Fluctuating cognition - Visual hallucinations

Question 22

Primary PD

Answer 22

• 85% of all cases - Unilateral onset that professes slowly

Question 23

Subtypes of primary PD: Tremor and postural instability/gait disturbance

Answer 23

Tremor - Earlier age onset - Slower progression - More favorable prognosis Postural instability/gait - Severe cognitive dysfunction - Rapid progression - Poor prognosis

Question 24

Two variants of postural instability/gait disturbance PD

Answer 24

Postural instability with falling (PIF) Freezing of gait (FOG)

Question 25

Dx of PD

Answer 25

• 2/4 symptoms present - Positive response to levodopa

Question 26

Vascular Parkinsonism

Answer 26

• One or small strokes - LEs are more affected - Resting tremor not common

Question 27

Drug-induced Parkinsonism

Answer 27

-Caused my neuroleptic/anti-psychotic mess - Symmetrical presentation - Tardive/Orolingual dyskinesia - Ceasing meds can reverse sxs but can take up to 2 years

Question 28

Toxins - secondary Parkinsonism

Answer 28

• Carbon monoxide - Heavy metals - Mercury

Question 29

Progressive supranuclear palsy

Answer 29

• Postural instability and falls - Vertical gaze paresis - Difficulty controlling eyes (stare) - Median survival time: 5.3 years

Question 30

Multiple systems atrophy

Answer 30

• Parkinsonism along with autonomic/cerebellum dysfunction - Median survival time: 8.5 years

Question 31

Corticobasalganglionic degeneration

Answer 31

• Focal rigidity with limb apraxia - Alien hand syndrome - Median survival time: 6-8 years

Question 32

Median survival time of idiopathic PD

Answer 32

15.8 years with PNA being most common reason of death

Question 33

Negative prognostic factors

Answer 33

• Younger age of onset - Early cognitive involvement - Lack of tremor at onset = PIGD

Question 34

Direct pathway

Answer 34

Question 35

Indirect pathway

Answer 35

Question 36

Modified Hoehn and YahrScale

Answer 36

Question 37

Unified Parkinson’s Disease Rating Scale

Answer 37