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49 Cards in this Set
- Front
- Back
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parkinson's is what type of disorder
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chronic progressive neurodegenerative disorder
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what is the pathology of parkinsons
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neuronal death in the substatnia nigra of the basal ganglia
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when do symptoms occur in parkinsons'
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not until 80% loss of dopamine producing neurons
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what is the result of decreased dopamine production
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changes in the firing patterns of neurons
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____ and ____ are responsible for emotion and thought
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caudate and putamen
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what reduces the information coding capacity of neuron pools
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rhythmic bursting and oscillations
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what happens due to the neuronal death in the substantia nigra that causes the symptoms of parkinsons
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decreased dopamine production and binding sites
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what is the overall function of the bG
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regulate muscle activity, tone, multijoint movements and sequencing of movements
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what is the role of the direct pathway in the BG
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facilitate BG output to cortex
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what is the role of the indirect pathway in the BG
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suppression of movement
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what cognitive processes is the BG involved in
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awareness of body orientation in space, adaptation and motivation
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if there are no direct connections of the BG to the LMN then how are they influenced
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through the motor planning parts of the cortex via thalamus and midbrain nuclei
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the mutually antagonistic sytems _____ and ______ balance eachother in the BG
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cholinergic and dopaminergic
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dopamine ____ and acetylcholine ____ results in an overactive indirect pathway
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dopamine INCREASE +
acetylchol DECREASE = overactive indirect pathway |
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what is rigidity
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increase in tone but not velocity dependent
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what is spacticity
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increased tone + velocity dependent
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what causes rigidity and bradykinesia
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increased activation of skeletomotor and fusimotor systems by corticospinal, reticulospinal, and rubrospinal pathways (overactive indirect)
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_____ direct pathway can also cause bradykinesia
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underactive direct pathway
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what causes tremor
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reduced serotonin
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uneractive indirect pathway is associated with ___ ____ and ____
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dyskinesia, dystonia, athetosis
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how common is parkinsons
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50,000/ year
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what is the age of onset for parkinsons
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usually >60 years with incidence and prevalence increasing with age
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________% of people are dx with parkinsons before 40
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5-10% dx before 40
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men to women for parkinsons
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men slightly >women
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race for parkinsons
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all
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genetics for parkinsons
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5-10% have a family hx, but <1% clearly familial
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what is the prognosis for PD
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not fatal but no cure
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what are the two protective factors that can reduce risk for parkinson's
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- caffeine
- nicotine |
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what do PD patients usually die from
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complications (aspiration, infection)
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what is the etiology for PD
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idiopathic, but theories include environmental, genetic (chromosome 4)
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what is diagnostic for classic parkinsons
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responsive to dopamine
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what is secondary parkinsonism
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known causes that trigger parksinonisms
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what are the causes for secondary parkinsonism
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- infections (inflenza)
- toxic (magnesium, CO) - pharmacologic (tardive dyskinesia) - metabolic (wilson's disease) |
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what are the parkinson-plus syndromes
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- multiple system atrophy
- progressive supranuclear palsy - dementia with Lewy bodies - vascular parkinsonism |
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how is PD dx
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- neuro assessment of clinical signs
- blood and radiology normal - R/O other disorders - lewy bodies seen on autopsy |
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when at least ____ of the primary symptoms are present, PD is assumed (list the primary symptoms)
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at least 2!
- termor - bradykinesia - rigidity - poor balance/ impaired postural reactions |
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what is festinating
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progressive acceleration of steps
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what are the types of medications used for PD
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- dopaminergics (simnet)
- synthetic agonists - anticholinergics - MOAs - enzyme inhibitors |
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what is the PRIMARY medication if seen in a chart tells you the patient has PD
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sinemet! it helps with rigidity (not tremor)
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what are the side effects that develop over time with dopaminergics
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dyskinesias/dystonias
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what do the MOAs do for PD
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prevent breakdown of dopamine possibly delays the need to start dopamine (only by about 9 montsh)
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what do the enzyme inhibitors do for PD
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help with the breakdown of dopamine
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what are the types of surgery for PD
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- thalamotomy
- pallidotomy - deep brain stim |
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what is a thalamotomy
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- helps with the tremor (BUT NOT WITH BRADY)
- put a lesion in the thalamus |
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what is a pallidotomy
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- improves bradykinesia, rigidity, tremor
- lesion in the globus pallitus |
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what is DBS
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deep brain stimulation
- electrical stim to specific nuclei replacing abnormal pattern of BG output |
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what is the medical tx of choice for PD
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DBS
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what must you have in order to be a candidate for DBS
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idiopathic PD
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what is the outcome of DBS
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only as good as their best "on med" but will extend the duration of quality "ON" time
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