week 5 Flashcards
symptom of parkinson’s , it is a jerky feeling in your arm or leg that healthcare provider can sense when moving or rotating your affected limb or joint
cogwheel motion
relax muscle, then flex and extend limb. physician are looking if muscle is stiff and infelxible when try to move it. Passive movement and if its rigid, then muscle do jerkiness as you do passive movement
test cogwheel motion
stooped posture, masked face, back rigidity, flexed elbows and wrists, tremors in the legs, forward tilt of trunk, reduced arm swing, hand tremor, slightly flexed knees, shuffling, short stepped gait
parkinsons disease symptoms
what are the four primary motor symptoms of parkinsons
resting tremor, rigidity, bradykinesia (slow movement), postural instability (balance problems)
is a rating tool used to gauge the severity and progression of parkinsons disease in patients, consists of 6 segments, gold standard by neurologists for monitoring response to medications used to decrease the signs and symptoms of parkinsons
unified parkinsons disease rating scale clinical rating system (UPDRS)
features segments require independent completion by people with disease and sections to be completed by clinician
-part 1: nonmotor experience of daily living
-part 2: motor experience of daily living
-part 3: motor examination
-part 4: motor complications
movement disorder society sponsored revision of the unified parkinsons disease rating scale (MDS-UPDRS)
leading causes of parkinsons disease?
age, drug use in the young, more advanced tools to detect, genetic, environment (pesticides)
what are components of the basal ganglia
substantia nigra, subthalamic nucleus, caudate, putaman, striatum, globus pallidus
damage (glutamate)= hemiballismus
subthalamic nucleus
damage (glutamate)= huntingtons
striatum
damage (GABA)= tourettes and supranuclear palsy
globus pallidus
which neurotransmitter is released from the neurons of the striatum that innervate the globus pallidus and the pars reticularis of substantia nigra?
GABA
which neurotransmitter is released from the neurons of the globus pallidus that project to thalamus and subthalamic nuclei?
GABA
which neurotransmitter is released from the neurons of the subthalamic nucleus that project to the internal globus pallidus?
glutamate
_____receptors are GPCRS
-the role of dopamine: regulate movement
dopamine
direct and indirect pathways operate in the _____
basal ganglia
boosts movement
direct pathway
inhibits movement
indirect pathway
parkinson disease is a defect in the _____ resulting in an increased signal from the indirect pathway
direct pathway
parkinsons gradual onset, usually begins with?
mild tremor of hands or feet while at rest
intention tremors are characteristics of _____
cerebellar disease
-tremors mostly seen during action
-family history reported in more than 50% of patients
-tremor usually affects both sides of the body initially (symmetrical)
-alcohol improves tremor
essential tremor symptom
-tremors seen at rest
-family history not as prominent
-tremor usually starts on one side of the body and progresses to the other side, usually remains asymmetrical
-tremor is not impacted by consumption of alcohol
parkinsons symptoms
as disease progresses, what happens?
tremor becomes more pronounced, bradykinesia and postural instability
____ symptoms of parkinsons
-bradykinesia, vocal symptoms, rigidity and postural instability, tremors, walking or gait difficulties, dystonia
motor skill symptoms
____symptoms of parkinsons
-mental/behavioral issues, senses of smell, sweating and melanoma, gastrointestinal issues, pain
nonmotor skill symptoms
-rapid eye movement sleep disorder (RBD)
-excessive daytime sleepiness (EDS)
-postural instability and gait disorder (PIGD) patients with parkinsons stooped posture, in parkinsons decrease arm swing and shuffling gait
prodromal symptoms
_____symptoms may occur 15-20 years before motor symptoms
prodromal
pathophysiology of parkinsons: loss of substantia nigra, the black deposition is due to
melanin
pathophysiology of parkinsons: damage to the neurons is associated with disruption of post translational trafficking of proteins. the proteins alpha synuclein binds to ___ which now can not be transported for secretion
ubiquitin
pathophysiology of parkinsons: ubiquitin and alpha synuclein accumulates within the cells as ____
lewy bodies
histology of parkinsons: has diminshed numbers of ____
pigmented neurons
why Levodopa as treatment for parkinsons?
crosses BBB and metabolizes dopamine
why is Levodopa combined with carbidopa?
it maintains it so it gets to the neurons and it gets metabolized before it gets to neurons (keeps it around longer)
what is a focused ultrasound of thalamus/subthalamic nuclei?
administer a drug to shut down bbb, send ultrasound waves to targeted brain area, it seems to benefit to motor systems
-progressive supranuclear palsy
-multiple system atrophy
-viral parkinsonism
-drug and toxin induced parkinsonism
-post traumatic parkinsonism
-cortical basal ganglionic degeneration
-lewy body diease
-normal pressure hydrocephallus (NPH)
parkinson like symptoms
-loss voluntary eye movements, reflexive eye movements are unaffected
-postural instability causing falls (specifically a tendency to fall backward)
-bradykinesia
-muscular rigidity with progressive dyskinetic movements due to disordered tonicity of muscle
-pseudobulbar palsy: difficulty swallowing (dysphagia) and speech disturbance (dysarthria) with emotional lability
-cognitive impairment
-sleep disturbances
-agitation, irritability, disinibition
-depression (late in course)
-dementia (eventually occurs)
symptoms of progressive supranuclear palsy
such as muscle rigidity and unsteady gait, these symptoms occur with other disorders so it makes the diagnosis more difficult. the physcial exam along with various autonomic tests and imaging studies, can help your doctor determine diagnosis
multiple system atrophy
these medications block the dopamine receptors in nerve cells. The resulting reduction in dopamine levels causes parkinsonism. typically, when someone stops taking these medications, the symptoms of parkinson decrease over time
drug-induced parkinsonism
it is hypothesized that a traumatic brain injury can damage neural tissue and induce the release of cellular breakdown products from damaged cells in the surrounding area. the cellular breakdown products can then act on neighboring healthy cells and promote intracellular alpha synuclein aggregation
post traumatic parkinsonism
-cerebral cortex and basal ganglia waste away
-rigidity and impaired balance usually begins on one side and spread to the other over time
cortical basal ganglionic degeneration
lewy body disease is generally diagnosed when at least 2 of the following features also occur with dementia?
changes in attention and alertness, visual hallucintaions, movement symptoms consistent with PD
these changes may last for hours or days. signs of these changes include staring in space, being lethargic or drowsy and having speech problems
changes in attention and alertness
hallucinations recur and are very detailed, they generally do not bother the person having them
visual hallucinations
these include slow movement, shuffling gait, rigidity and falls. the person may also have tremors. but they are not as pronounced as in a person with PD with dementia
movement symptoms consistent with PD in lewy body disease
the cause of excess fluid in the ventricles of the brain may be due to injury, bleeding, infection, brain tumor or surgery on the brain. however the cause is often ____
not known
normal pressure hydrocephalus though rare, most often affects older adults, and its symptoms can be similar to those of ____ and ____
Alzheimer and Parkinson disease
