Workshop 7: Parkinson's Disease

Question 1

Recap: Cerebellum structure and function

Answer 1

▪ Not part of brainstem
▪ Part of metencephalon (along with Pons)
▪ 2 hemispheres
▪ Functions ipsilaterally (same side controlled)
▪ Connected to brainstem – cerebellar peduncles
▪ Outer surface = tightly folded
* increases surface area and density of neurons
▪ Accounts for >50<80% of brain neurones - condensed

	○ Coordinates and smooths movement - e.g. balance, eye movement Provides feedback to the motor somatosensory region of the cortex

Question 2

What is Parkinson’s disease?

Answer 2

Progressive neurodegenerative disease

Question 3

Parkinson’s disease: symptoms

Answer 3

Impairment of movement initiation (e.g. bradycardia, slurred speech) , particularly automatic (i.e. balance)

Affects nerve cells in substantia nigra which produces dopamine - lack of dopamine, which helps control movement = where symptoms start

Primary symptom: the tremor

Question 4

Parkinson’s disease: When do symptoms begin?

Answer 4

When 80% of dopamine is lost, PD symptoms occur, such as tremor, slowness of movement, stiffness, balance..

Question 5

Parkinson’s: causes

Answer 5

Genetic (10-15%)?

Environment (head injury, pesticides)?

Ageing?

(Note that this is a difference to Huntington’s which is entirely genetic)

Question 6

Parkinson’s: Populations most affected

Answer 6

○ Around the age of 60 years diagnosis (see graph below)

	○ Men appear to get it more frequently (1.5x more likely than females)

	○ Around 150,000 sufferers in the UK currently

(Diagnosis isn’t entirely easy - symptoms can vary in intensity, quite a few symptoms vary)

Question 7

Parkinson’s: Treatments

Answer 7

• Self care (exercise) (to maintain activity levels, mental health, can slow down decline, nutrition)

    * Medication (drug pump to avoid fluctuations in dose effects) 

• Surgery (deep brain stimulation, thalamus)

Question 8

Parkinson’s vs Huntington’s

Answer 8

They are both progressive neurodegenerative diseases that affect movement but differ in cause, symptom, and treatment

Causes:
P: lack of dopamine due to substansia nigra, genetic? ageing? environment?
H: 100% genetic & Earlier onset

Symptoms:
P: Tremors, rigidity, fatigue, emotional changes
H: Uncontrolled movements, slurred speech, impaired coordination, behavioural changes

Treatment:
P: Medication, surgery, self-care
H: Mainly medication

Question 9

Neurological test for cerebellum function:

Answer 9

▪ Speech test – Say ‘British Parliament’
* enunciation of individual syllables suggest cerebellum disfunction.

▪ Nystagmus 
		§ Rhymical, repetitive movement of the eyes

▪ Finger to Nose, finger to finger 

▪ Rebound phenomena ---- people with malfunctioning cerebellum, if you hold their arm up, then let their arm go, they wouldn't be able to stop them from hitting themselves.

▪ Rapid alternate movement ---- test rapid hand movements

▪ Gait - wating their gait/ walk - cerebellum problems = a wider gait, shuffle more

▪ Posture - slumped

▪ Reflex - (e.g. the platella reflex test - someone with problems, their leg will rebound multiple times)

(The blind flamingo task - athletes vs other people)