Basal Ganglia Diseases

Front 1

What is the TRAP signs for parkinsonism?

Back 1

-Tremor at rest
-Rigidity
-Akinesia (or bradykinesia)
-Postural instability

Front 2

T or F:
Parkinsonism affects proximal muscles early and spreads to face and extremities?

Back 2

TRUE

Front 3

_______________ is a jerky, ratchetlike resistance to passive movement as muscles alternately tense and relax.

Back 3

COGWHEEL

Front 4

____________ is a slowed or difficulty maintaining movement?

Back 4

-Bradykinesia

Front 5

What is the inability to initiate movement?

Back 5

-Akinesia

Front 6

__________________ is one of the most common signs present at initial diagnosis

Back 6

Resting tremors

"pill-rolling"

Front 7

Which type of falls are very common with parkinsonism and why?

Back 7

-Forward Falls

-Rapid, festinating gait in combination with a stooped posture leads to forward falls.

Front 8

What are a few other common motor signs with parkinsonism?

Back 8

-Masked face
-Micrographia
-Slowing of ADLs
-Stooped, shuffling gait
-Decreased arm swing when walking
-Hypophonia
-Swallowing and chewing difficulty

Front 9

Parkinsonism from strokes, toxins, trauma (boxing), infections (encephalitis, HIV), metabolic abnormalities (hypo- or hyper- thyroidism or parathyroidism, liver failure), drug-induced is known as?

Back 9

Secondary parkinsonism

Front 10

What is the most common parkinson-plus syndrome?

Back 10

-Progressive Supranuclear Palsy

Symptoms include: postural instability leading to falls within first year of disease onset; supranuclear ophthalmoplegia: vertical gaze paresis, especially in the downward direction.

Front 11

What is the key sign you see with Progressive Supranuclear Palsy?

Back 11

-VERTICAL GAZE PALSY

Front 12

Which part of the brain is the Substantia Nigra Pars Compacta located?

Back 12

-MIDBRAIN

Front 13

Symptoms of Parkinson begin with Lewy Bodies reach/affect _______?

Back 13

Midbrain, specifically the substantia nigra pars compacta

Front 14

NORMAL ACTIVITY

Back 14

-Normally the D1 and D2 are balanced as shown, and we are able to both initiate wanted movements (D1) and inhibit unwanted movements (D2)

Front 15

PARKINSON ACTIVITY

Back 15

1a) Direct path gets less excitation:
1b) Inderect gets less inhibition
2) Causing increase unwanted movements (cant inhibit)
3) Causing increase difficulty with wanted movements (due to less excitation)
4)

Front 16

The causes direct excitation:

Back 16

D1

-This allows us to choose and perform motion

Front 17

This causes direct inhibition:

Back 17

D2

-This allows us to inhibit unwanted movements

Front 18

How is a clinical diagnosis of Parkinson disease made?

Back 18

-Must have 2 of 4 cardinal signs (TRAP)
-Tremor
-rigidity
-akinisea
-postural instability

Front 19

A definitive diagnosis of Parkinson disease can be made how?

Back 19

-Autopsy

Front 20

The following are associated with getting Parkinson disease:

Back 20

-Olfactory deficits
-Obesity
-Constipation
-Slow reaction time

Front 21

What are three symptoms that will give a worse prognosis for PD?

Back 21

-Older age at onset (> 57 years)
-Rigidity/hypokinesia as a presenting symptom
-PIGD

Front 22

What is PIGD?

Back 22

Postural Instability
Gait Disturbances

Front 23

T or F:
Deep brain stimulation is another option for treating parkinson disease?

Back 23

TRUE

-Indicated when person has symptoms not adequately controlled with medications.
-Person still has to have a good response to levodopa.

Front 24

What drug will a younger patient commonly begin with?

Back 24

-May start with Dopamine agonist then advance when needed to a levadopa/sinemet

Front 25

T or F:
Deep brain stimulation has great effects on Gait and balance in Parkinson disease?

Back 25

FALSE

-Non-motor symptoms (gait and balance) of PD not affected by DBS

Front 26

Describe "BIG therapy"?

Back 26

-Treatment effective in treating speech and voice disorders of patients with PD

-Very large exaggerated movements and speech to break motor patterns and reteach "norms"