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PSY325 > Week 7 - Parkinson's > Flashcards

Week 7 - Parkinson's Flashcards

1
Q

How many people are currently affected by Parkinson’s disease in Australia?

A

40,000

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2
Q

How many people worldwide suffer from Parkinson’s disease?

A

10 million

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3
Q

What are the major symptoms of parknson’s disease?

A

Bradykinesia

Tremor

Rigidity

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4
Q

What is the anchor feature of parkinsonism?

A

Bradykinesia

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5
Q

What is bradykinesia an umbrella term for?

A

Reduced movement speed

Amplitude (hypokinesia)

and slowness of movement initiation

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6
Q

What are some examples of bradykinesia?

A

Gross movements ae slowed such as

rising from chair, walking

fine movements such as tapping fingers

handwriting small and imprecise

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7
Q

What is a resting tremor?

A

Shaking that occurs in relaxed muscles (typically in extremities such as hands

Fingers demonstrate a twitching motion while at rest

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8
Q

What is rigidity?

A

Described as cogwheel rigidity because the increases muscle tension that feels ratchet-like when resistance is applied

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9
Q

What is dysarthria?

A

Weakness in the muscles used for speech, which often causes slowed or slurred speech. A late feature of parkinsons

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10
Q

What is dysphagia?

A

A late feature of PD

Difficulty swallowing foods or liquids

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11
Q

What are postural deformities in parkinsons?

A

A stooped posture with flexion of the trunk

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12
Q

What is dystonia?

A

Involuntary muscle contractions that cause repetitive or twisting movements

Rare feaure of idiopathic PD

Not uncommon in autosomal recessive forms with young-onset disease

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13
Q

how common is dementia in idiopathic parkinsons?

A

Common late feature

affects70-80% of patients after prolonged disease lasting 10 or more years

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14
Q

What are the risk factors for dementia in parkinsons disease??

A

Age

Longer duration of disease

being male

having visual hallucinations

older age of onset of parkinsons

family history

more severe motor symptoms

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15
Q

How is parkinson’s dementia different from Alzheimers disease?

A

Dementia is a hallmark of alzheimers where as dementia may or may not occur in people with parkinsons

Dementia has greater social and occuptional impact in parkinsons as there are motor and cognitive impairments

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16
Q

How common are depressive symptoms in parkinsons?

A

30-40% of patients experience low mood and lack of interest/pleasure (Anhedonia)

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17
Q

How common is anxiety in people with parkinsons?

A

affects up to 40% of patients

Some people may experience:
 generalised anxiety disorder, 
anxiety attacks
social avoidance 
OCD
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18
Q

Parkinsons is primarily linked to a central dopamine deficit, what other neurodegenerative events may also occur?

A

noradrenergic nuclei

serotoninergic nuclei

cholinergic nuclei

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19
Q

What is the most common type of psychotic symptom in parkinsons?

A

Visual hallucinations

Delusional behaviour

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20
Q

What percentage of parkinsons patients experience psychotic symptoms?

A

up to 50%

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21
Q

What are the two groups of parkinsons?

A

degenerative parkinsonism

symptomatic or secondary parkinsonism

22
Q

What is degenerative parkinsonism?

A

a variety of sporadic and genetic degenerative diseases cause neurodegeneration

23
Q

What is symptomatic or secondary parkinsonism?

A

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

24
Q

Which type of parkinson’s disease is likely to be multifactorial and is considered to be environmental as well as genetic?

A

sporadic or idiopathic

25
Q

What are the different kinds of symptomatic parkinsonism?

A

infectious

toxic

drug-induced

brain tumours

metabolic

26
Q

How is the aetiology of neurogenerative and symptomatic forms of parkinsonism usually defined?

A

in terms of functional or structural disorders

affecting nigrostriatal dopamine transmission and/or downstream signalling pathways

27
Q

What brain areas contain the brain structures of the basal ganglia?

A

telencephalon

diencephalon

mesencephalon

28
Q

What forebrain structures are involved in the basal ganglia?

A

caudate nucleus

putamen

nucleus accumbens (or ventral striatum)

Globus pallidus

29
Q

What two brain structures of the basal ganglia are considered to be functionally equivalent to each other?

A

caudate nucleus

putamen

30
Q

Most mammals only have a single nucleus called the _____.

A

Striatum

31
Q

What are the two segments of the globus pallidus?

A

internal (or medial) segment

External (or lateral) segment

32
Q

Where is the subthalamic nucleus located?

A

part of the diencephalon

located just below the thalamus

33
Q

Where is the substantia nigra located?

A

midbrain

34
Q

What are the two distinct parts of the substantia nigra?

A

pars compacta (SNpc)

pars reticulata (SNpr)

35
Q

What structure is the source of a clinically important dopaminergic pathway to the striatum?

A

pars compacta

36
Q

What happens if there is a loss of neurons in the pars compacta?

A

cause of parkisons disease

this pathway referred to as nigrostriatal dopamine pathway

37
Q

What is the dopamine pathway from the pars compacta to the striatum referred to?

A

nigrostriatal dopamine pathway

38
Q

What are the two pathways in the basal ganglia that control the fine tuning of voluntary motor activities?

A

direct excitatory pathway

indirect inhibitory pathway

39
Q

What happens when the direct excitatory and indirect inhibitory pathways are stimulated?

A

they have antagonistic net effects

stimulation of direct pathway: activation of motor cortex

stimulation of indirect pathway: inhibition of motor cortex

40
Q

How does dopamine act on the direct pathway neurons?

A

activating dopamine D1 receptors

these receptors are linked to Gs proteins which stimulate cell activity through activation of adenylyl cyclase

41
Q

how does dopamine act on the indirect pathway neurons?

A

Activating dopamine D2 receptors

these receptors are coupled to Gi proteins which inhibit cell activity by decreasing adenlyl cyclase activity

42
Q

D1 and D2 receptors are expressed on two separate populations, what does this mean?

A

A change in dopaminergic tone alters the output of the striatum

43
Q

In parkinsons, which areas are hyperactive and cause thalamocortical projections to be inhibited?

A

STN (subthalamic nucleus)

GPi (globus pallidus)

44
Q

What is levodopa (L-dopa)?

A

The most effective symptomatic treatment of parkinsons

45
Q

What are the limitations of levodopa?

A

“dopa resistant” motor symptoms (postural abnormalities, freezing episodes, speech impairment)

“dopa resistant” non-motor signs (autonomic dysfunction, mood and cognitive impairment etc)

Drug related side effects (especially psychosis, motor fluctuations and dyskinesias)

46
Q

What are some other types of pharmacological treatments of parkinsons (aside from levodopa)?

A

Dopamine agonists

COMT inhibitors

MAO-B inhibitors

Anticholinergics

Amantadine

47
Q

How do dopamine agonists treat parkinsons?

A

Idea is to stimulate dopamine receptors directly

Dopamine agonists are not a potent as levodopa and may be less likely to cause dyskinesias

48
Q

How do COMT inhibitors treat parkinsons?

A

used in combination with levodopa

block the action of enzymes that break down levodopa

49
Q

How do MAO-B inhibitors treat parkinsons?

A

Stop the breakdown of dopamine in the brain

50
Q

How do anticholinergics treat parkinsons?

A

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

51
Q

How does amantadine treat parkinsons?

A

Antiviral drug used for people who may have developed dyskinesias following long-term use of levodopa

52
Q

What is deep-brain stimulation?

A

surgical technique

treat severe cases of PD

during times of extreme tremor the patient can activate the pacemaker which stimulates the subthalamic nucleus

stops tremor activity by bradykinesia and rigidity often persist

PSY325 (11 decks)

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