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NEUROPSYCH & CLINICAL NEURO > Week 7: Movement disorders > Flashcards

Week 7: Movement disorders Flashcards

1
Q

What are movement disorders?

A
  • Abnormality in form and velocity of movements

- associated with neuropsychological deficits

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2
Q

Movement disorders have become synonymous with…

A

Basal ganglia disease

  • Not always the origin of causation
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3
Q

Why is it not surprising the movement disorders can have neuropsychological affects?

A

Because the basal ganglia has extensive connectivity

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4
Q

Movement control requires what two systems

A

musculoskeletal and nervous system

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5
Q

What are the 3 stages of movement?

A

Planning, initiation and execution

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6
Q

What areas are involved in the planning of movement?

A

Cerebellum and BG

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7
Q

What areas are involved in the initiation of movement?

A

Motor cortex

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8
Q

What areas are involved in the execution of movement?

A

Alpha motor neurons and the cerebellum for fine-tuning movements

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9
Q

Movement is part of a circuit - explain the highest level?

A

Memory, emotion and motivation - intent to move is formed (command neurons)

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10
Q

Movement is part of a circuit - explain the middle levels

A

Information from the higher level is relayed here

  • postures and movements required determined
  • feedback loops to modulate the activity
  • receive input from receptors in muscles, joints, skin

Creates a motor program, defines what is available to perform the desired task

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11
Q

Movement is part of a circuit - explain the local levels

A

Receptors send messages to the brain stem and spinal cord - motor neurons then send back to muscle fibres

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12
Q

Akinetic-rigid disorders?

A

Akinesia, bradykinesia and hypokinesia

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13
Q

What is Akinesia?

A

Lack of movement

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14
Q

What is bradykinesia?

A

Slow movement - speed of initiation and execution of purposeful and automatic movements

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15
Q

What is hypokinesia?

A

Poverty of movement - small in amplitude

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16
Q

Hyperkinetic disorders?

A

Jerky and non-jerky syndromes

Recognition and diagnosis of these are difficult

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17
Q

What are some of the jerky hyperkinetic disorders?

A

Myoclonus: sudden brief, shock-like involuntary movements.

Chorea: Quick, irregular, semi purposive involuntary movements

Tics: abrupt, jerky, non-rhythmic movements of sounds that are temporarily suppressible by will power. Preceded by a feeling of discomfort or an urge that is relieved by the tic

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18
Q

What are some of the non-jerky hyperkinetic disorders?

A

Tremor: Involuntary, rhythmic muscle contractions and relaxations involving oscillations or twitching movements by 1 or more body parts

Dystonia: abnormal movement, uncontrollable muscle contractions. affected body part twists uncontrollably - repetitive movements or abnormal pressure

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19
Q

What is huntingtons disease?

A

A progressive disorder combining chorea with behavioural disturbances and dementia

Abnormally large repeats of CAG (neucletide sequence) on chromosome 4

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20
Q

Huntingtons is genetic. What is the inheritability rate?

A

50%

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21
Q

Does parkinsons incidence increase with age?

A

Yes

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22
Q

Are there any gender differences in parkinsons?

A

Yes. More common in men

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23
Q

How many parkinsons patients suffer from cognitive deficits?

A

1/3

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24
Q

What did James Parkinson describe parkinsons as?

A

Involuntary tremulous motion, with lessened muscular power. Propensity to bend the trunk forward and to pass from a walking to a running pace, the senses and intellects being uninjured

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25
Q

What is a limitation to the way james parkinson described parkinsons disease?

A

He did not account for or recognise any cognitive impairments

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26
Q

What is parkinsons?

A

A progressive, degenerative disorder of the central nervous system

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27
Q

Is there a cure for parkinsons?

A

No. There is no way to replace the neurons that die

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28
Q

What are the major symptoms of parkinsons?

A

Bradykinesia

With the presence of at least one of the following: Temor, impaired postural reflexes and rigidity

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29
Q

How do those with parkinsons walk?

A

Slowed gait, feet tend to shuffle along the floor as if weighted down

30
Q

Gross and fine motor skills in parkinsons?

A

Both are slowed.

Handwriting becomes small and imprecise

31
Q

Resting tremor is a symptom of parkinsons - what is it?

A

Shaking that occurs in relaxed muscles - typically outer extremities such as the hands or feet (e.g. fingers display a regular twitching motion while at rest - pill-rolling tremor)

Occurs from activation of opposing muscles that alternated between contraction and relaxation

32
Q

Rigidity is a symptom of parkinsons - what is it?

A

Increased muscle tension that feels rachet-like when resistance is applied

Repeated movements of arm and leg joints result in muscular stiffness, and movements take on a jerky quality

33
Q

What postural deformity is common in parkinsons?

A

A stooped posture with flexion of the trunk

34
Q

Parkinsons patients have difficulty in swallowing foods and liquids. What is this called?

A

Dysphagia

35
Q

Slowed or slurred speech is common in later parkinsons why?

A

Because of a weakness in the muscles used for speech. This is dysarthria

36
Q

Dementia prevalence in parkinsons?

A

It is a common late feature of idiopathic Parkinsons affecting 70-80%

37
Q

How long after the onset of parkinsons, does dementia occur?

A

A year or more after

38
Q

What is it when dementia symptoms appear at the same time as motor symptoms?

A

Dementia with Lewy bodies

39
Q

Does dementia always occur in parkinsons disease?

A

No.

40
Q

Those with parkinsons dementia have additional struggles with…

A

Social and occupational functioning

41
Q

What are the biological hallmarks of parkinsons dementia?

A

Similar to dementia with lewy bodies

- sticky clumps of protein found in neurons

42
Q

What increases the risk of parkinsons dementia?

A 
Increasing age
Advanced disease stage 
Being male 
Having hallucinations 
Older age at onset of parkinsons 
Family history of dementia 
More severe motor symptoms
43
Q

What are movement deficits primarily linked to?

A

Dopamine deficits

44
Q

What percentage of patients with parkinsons have depressive symptoms?

A

30-40%

45
Q

What percentage of patients with parkinsons have anxiety? and what kinds?

A

40%

GAD, anxiety attacks, social avoidance and even OCD

46
Q

Psychotic symptoms in parkinsons?

A

May affect up to 50%

May include visual hallucinations and delusional behaviour

47
Q

Explain the parkinsons iceberg

A

People see some symptoms at the tip of the iceberg - rigidity, tremor, bradykinesia and postural disturbance

But what they don’t see is what is under the water - speech, panic attacks, swallowing problems lack of facial expression, pain, depression, anxiety, hallucinations, sweating

48
Q

What are the 2 different categories of parkinsons?

A

Degenerative & symptomatic/secondary

49
Q

What is degenerative parkinsonism?

A

Sporadic and genetic degenerative diseases cause nigrostriatal neurodegeneration

50
Q

What is symptomatic/secondary parkinsonism?

A

Caused by non-degenerative lesions of the same system or other sites of the striatopallidothalamic-cortical motor circuitry

E.g. infectious, toxic, drug-induced, brain tumours, metabollic

51
Q

The cause of both neurodegenerative and symptomatic parkinsons is

A

disorders that affect the nigrostriatal dopamine transmission and or downstream signalling pathways

52
Q

What is the basal ganglia?

A

Brain area comprised of a set of brain structures in the telencephalon, diencephalon and mesencephalon

53
Q

What are the forebrain components of the basal ganglia?

A

Caudate nucleus, putamen, nucleus accumbens and the globus pallidus

54
Q

Which two regions of the BG are considered the striatum?

A

The caudate nucleus and the putamen

55
Q

What is the substantia nigra and how does it relate to parkinsons?

A 
Part of the BG
Contains dopamine neurons 
2 parts: 
- pars compacta - dopaminergic pathway to the striatum - loss of neurons here is the cause of parkinsons 
- pars reticulata
56
Q

What are the two pathways of the BG?

A

Direct excitatory pathway (dopamine D1): activation of the motor cortex. The accelerator as the direct pathway inhibits the basal ganglia - meaning it doesnt have as much control as it normally does

Indirect inhibitory pathway (dopamine D2): inhibition of the motor cortex. is the brakes! excites the basal ganglia and therefore it has its normal control, inhibiting output

57
Q

Which BG pathway do we use?

A

Both at the same time - in balance

58
Q

What is Levodopa (L-DOPA)?

A

Most effective symptomatic treatment of parkinsons

59
Q

Problems with L-DOPA?

A

There are some resistant symptoms: postural abnormalities, freezing episodes and speech impairments (motor), mood and cog impairment (non-motor)

Drug related side effects: psychosis, motor fluctuations,

60
Q

Plain L-DOPA produces… and we fix it by….

A
  1. Nausea

2. Combining with carbidopa to prevent nausea

61
Q

What are dopamine agonists?

A

Stimulate dopamine receptors directly

62
Q

COMT inhibitors?

A

Are used in combination with L-DOPA. They black the action of enzymes that break down the drug

63
Q

What are MAO-B inhibitors?

A

They stop the breakdown of dopamine in the brain - the longer you can keep dopamine available in the brain, the better

64
Q

What are anticholinergics?

A

Can be helpful for tremor and may ease dystonia associated with wearing-off or peak-dose effect of levodopa

65
Q

What is amantadine?

A

Antiviral drug used for people who may have developed dyskinesias following long term Levodopa use

66
Q

What surgical technique has been developed to treat severe cases of parkinsons?

A

Deep brain stimulation

67
Q

How does deep brain stimulation work?

A

Very thin wire electrodes are inserted through the skull and brain into the subthalamic nucleus

A connected wire is inserted into the chest under the skin (pacemaker-like control device)

During times of extreme tremor the patient can activate the pacemaker which electrically stimulates the subthalamic nucleus - stops tremor activity

68
Q

Limitations to symptom relief after deep brain stimulation?

A

while the tremors stop, bradykinesia and rigidity often persist

69
Q

Dangers of deep brain stimulation?

A

Invasive - low but potentially serious risks of haemorrhaging and infection

70
Q

What else can dep brain stimulation be used for?

A

MDD, OCD, AD, PD, pain and addiction

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