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Adult Neuro One > PD and HD > Flashcards

PD and HD Flashcards

1
Q

basal ganglia role

A
  • plans willed movements
  • regulates muscle tone
  • regulates force production
  • motor learning
    *execution of automatic and repetitive movement
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2
Q

the direct motor loop of the basal ganglia is ______ while the indirect look is _______

A

excitatory - initiates movement
inhibitory - suppresses movement

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3
Q

what neurotransmitter has a major impact on the two pathways of the basal ganglia

A

dopamine

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4
Q

a decrease in dopamine creates an overactive _____ pathway leading to…

A

indirect
akinesia and rigidity

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5
Q

a decrease in dopamine creates an underactive ___ pathway leading it

A

direct
bradykinesia

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6
Q

motor circuit of basal ganglia is for….

A

motor control

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7
Q

oculomotor circuit of basal ganglia is for..

A

eye sccades

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8
Q

prefrontal circuit of basal ganglia is for…

A

behavior, problem solving, cognition

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9
Q

limbic circuit of basal ganglia is for…

A

motivation, learning, memory, sleep/wake

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10
Q

huntingtons disease involves deterioration of the…

A

striatum (caudate/putamen) *will eventually affect entire brain

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11
Q

HD is autosomal-____. what does this mean?

A

dominant
*if you inherit the gene, you will 100% get HD

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12
Q

genetically, HD is caused by 37 repeates of ______

A

CAG (cytosine - adenine - guanine)

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13
Q

T or F: HD is progressive

A

T but is rare disease

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14
Q

age for adult onset of HD? juvenile? late?

A

adult = 30-50
juvenile = <20
late = >59

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15
Q

2 HD specific outcome measures

A

1 - unified HD rating scale
2 - total functional capacity scale

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16
Q

which HD outcomes measure is used for staging? how many stages of HD?

A

total functional capacity scale
5

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17
Q

HD is a ______kinetic disease

A

HYPERkinetic
*issues with inhibiting movement

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18
Q

common cognitive impairments with HD

A

loss of focus, slow thinking, lack of impulse control, inability to multitask

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19
Q

most common psychiatric impairment with HD

A

depression

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20
Q

two movement disorders associated with HD

A

chorea and dystonia

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21
Q

chorea

A

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face

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22
Q

dystonia

A

movement disorder in which a person’s muscles contract uncontrollably

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23
Q

T or F: there is strong evidence to support PT interventions to improve fitness, motor function, and gait in people with HD

A

T

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24
Q

parkinson’s is the ___ most common progressive neurological disorder

A

2nd
Alzheimers is the 1st

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25
Q

cause of PD

A

not sure, but thought to be a combination of genetics and environmental exposures

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26
Q

is PD more common in men or women

A

men

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27
Q

PD is usually diagnosed at age _____ or older

A

65

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28
Q

PD is a _____kinetic disorder

A

HYPOkinetic

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29
Q

PD is due to a loss of dopamine caused by degeneration of the _____

A

substantia nigra

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30
Q

______-______% of dopaminergic neurons are depleted before seeing motor symptoms in PD

A

60-80

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31
Q

characteristic features of PD

A

T = tremor (usually starts unilaterally)
R = rigidity
A = akinesia/bradykinesia
P = posture/balance

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32
Q

tremor

A

involuntary shaking or oscillating movement

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33
Q

tremors are seen in about ___% of people with PD

A

80

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34
Q

what kind of tremor in PD

A

resting
*some pts also c/o internal tremors

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35
Q

T or F: stress increases tremor

A

Tr

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36
Q

Rigidity

A

increased resistance to passive movement

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37
Q

T or F: rigidity is velocity dependent

A

F, spasticity is

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38
Q

does rigidity affect proximal or distal muscles first

A

proximal

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39
Q

cogwheel rigidity

A

jerky, ratchet-like resistance to passive movement (on/off resistance)

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40
Q

lead pipe

A

sustained resistance to passive movement

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41
Q

what is the difference between akinesia and bradykinesia?

A

akinesia is the absence of movement while bradykinesia is the decreased speed of movement
*akinesia is a progression of bradykinesia

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42
Q

hypokinesia

A

decreased AMPLITUDE of movement

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43
Q

what is an early clinical sign involving gait in PD

A

decreased amplitude of arm swing on one side

44
Q

what is an early sign of PD in the eyes? what about in the face?

A

eyes = saccadic hypometria
face = reduced frequency of blinking, diminished facial animation

45
Q

Pts w/ PD typically have increased LE ___ activation causing _____

A

flexor
retropulsion
*extensors are weak

46
Q

what is the #1 cause of death in PD

A

aspiration pneumonia due to swallowing issues

47
Q

what do you often see in PD when it comes to handwriting

A

micrographia = small handwriting

48
Q

T or F: dysarthria and dysphagia is common in PD

A

T: affects 95% of pts

49
Q

sialorrhea

A

excessive drooling

50
Q

What do PD patient often have involving their voice

A

hypophonia = decreased volume

51
Q

how is PD diagnosed

A

presence of 2/4 cardinal motor feature and responsive to meds = PD diagnosis

52
Q

T or F: there is a single test/group of tests to diagnose PD

A

F: based on history and clinical exam

53
Q

T or F: Parkinsonism’s respond to PD meds

A

F

54
Q

is procedural learning affected in PD? what about declarative

A

procedural = yes
declarative = no

55
Q

since declarative learning is unaffected, what kind of cues are important in PD

A

verbal
visual
external

56
Q

2 outcome measures for staging PD

A

1 - Hoehn and Yahr
2 - unified PD rating scale

57
Q

H and Y stage 0

A

no signs of disease

58
Q

H and Y stage 1

A

unilateral disease

59
Q

H and Y stage 1.5

A

unilateral plus axial involvement

60
Q

H and Y stage 2

A

bilateral disease w/o impairment of balance

61
Q

H and Y stage 2.5

A

mild bilateral disease, recovery on pull test

62
Q

H and Y stage 3

A

mild to mod bilateral disease; some postural instability but still able to live independent

63
Q

H and Y stage 4

A

severe disability, still able to walk or stand unassisted

64
Q

H and Y stage 5

A

wheelchair bound or bedridden unless aided

65
Q

what is the gold standard scale to stage PD? is a higher or lower score greater disability?

A

unified PD rating scale
higher

66
Q

Your pt with PD has a tremor in one hand, and rigidity and clumsiness in one leg. He has decreased blinking and some speech abnormalities. Is he in the early, middle, or advanced stages of PD?

A

early

67
Q

Your pt with PD has compromised balance and cannot make rapid adjustments. He has tremors and rigidity bilaterally. Is he in the early, middle, or advanced stages of PD?

A

middle

68
Q

Your pt w/ PD has freezing of gait and struggles to walk/stand unassisted. He has tremors and rigidity, as well as cognitive impairments and PD dementia. He is unable to live alone. Is he in the early, middle, or advanced stages of PD

A

advanced

69
Q

T or F: freezing of gait only happens in the late stages of PD

A

F: it can happen at any stage

70
Q

young onset PD starts before age _______

A

55

71
Q

T or F: genetics play a larger role in young-onset PD

A

T

72
Q

T or F: young-onset PD progress faster

A

F: slower
*but freezing usually comes earlier

73
Q

dystonias

A

abnormal muscle contractions… almost like a cramp
*more common in young-onset PD

74
Q

what is the most common form of parkinsonism

A

progressive supranuclear palsy

75
Q

what is the specific diagnostic feature of supranuclear palsy

A

supranuclear gaze palsy
** you don’t lose this with parkinsons

76
Q

supranuclear gaze palsy

A

loss of vertical eye movements with inability to look down

77
Q

T or F: tremors are rare in progressive supranuclear palsy

A

T

78
Q

progressive supranuclear palsy symptoms

A

FIGS
F = frequent sudden falls
I = ineffective meds
G = gaze palsy
S = speech/swallowing difficulties

79
Q

this is the 2nd most common form of parkinsonism

A

multiple system atrophy

80
Q

multiple system atrophy

A

autonomic system starts to fail
*progresses rapidly

81
Q

lewy body dementia

A
  • parkinsonism with early dementia
  • visual hallucinations, impaired executive function, agitation
82
Q

what is vascular parkinsonism caused by? is it progressive?

A
  • small CVAs to basal ganglia
  • not progressive
83
Q

does vascular parkinsonism cause more symptoms in UE or LE

A

lower

84
Q

what is the purpose of a DaTscan

A

developed to distinguish between PD and essential tremor

85
Q

T or F: SaTscans diagnose PD

A

F: it will appear abnormal in ANY disease with a loss of dopamine

86
Q

T or F: MRI appears normal in PD

A

T

87
Q

2 possible locations for deep brain stimulation for PD. which is most common?

A

1 - subthalamic (most common)
2- globus pallidus interna

88
Q

T or F: deep brain stimulation cures PD

A

F: it decreases the need for medications in some but it will not make the symptoms any better than their best on time with meds

89
Q

T or F: those with parkinsonism syndromes will benefit from deep brain stimulation

A

F

90
Q

T or F: there is an increased risk for falls after deep brain stimulation. Why or Why not

A

T: because they are able to move faster but are not able to catch their balance yet

91
Q

what are the two gold standard meds for PD and how do they work

A
  • carbidopa and levodopa
  • dopamine agonist
    *they have a lot of crazy side effects
92
Q

T or F: food can play a role in the effectiveness of meds

A

T

93
Q

T or F: you should only asses patients on their on times with meds

A

F: you want to assess and treat during the off times if possible because you need to see them at their worst

94
Q

T or F: domapinergic therapy improves cognitive function and motor learning

A

F
* gait and balance impairments also persist
*aka: you still need exercise

95
Q

with PF, it is important to look at _____ of movement

A

quality

96
Q

most common areas of pain and cause of pain in PD

A

back and shoulder caused by rigidity

97
Q

why do pts with PD tend to do better with stairs

A

it is a continuous external cue

98
Q

freezing of gait

A

unwanted stop in forward progression of gait, feels like their feet are stuck to the floor
*stress, distractions, and turning are triggers

99
Q

festination

A

tendency to move forward with increasingly rapid small steps

100
Q

what is the goal when treating freezing of gait? how can you do this?

A
  • reduce frequency of freezing
  • progress from closed to open environments
  • identify freezing triggers and include them
  • gradually add distractors
101
Q

you are gait training with you pt who has PD and they experience a freezing of gait. what do you do?

A

1 - stop
2 - stand tall
3 - shift weight
4 - step big

*never fight a freeze b/c they will fall

102
Q

what is the biggest predictor of future falls in PD? what about of the first fall?

A
  • fall history
  • decreased gait speed and SLS time
103
Q

T or F: when exercise is introduced early in PD, progression can be slowed

A

T: dopaminergic neurons are highly responsive to exercise and activities that are rewarding increase dopamine levels

104
Q

T or F: amplitude matters at all stages and ages of PD

A

T
*people with PD feel like normal movements are too large. have them move big!

105
Q

why do external cues work so well in PD?

A

they bypass the damaged basal ganglia to use cortical areas for movement initiation and control

106
Q

what PRE do you want patients with PD to stay between

A

13-16 (moderately hard-hard)
*intensity matters!

Adult Neuro One (10 decks)

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