CHAPTER 21 - THE PARKINSON'S DISEASE SPECTRUM

In what two domains can parkinson be distinguished in?

1) atypical parkinsonisms

2) vascular parkinsonism

vascular parkinsonism

cerebrovascular damage

atypical parkinsonisms has 4 subtypes

1) mutliple system atrophy

2) progressive supranuclear paralysis

3) corticobasal degeneration

4) Lewy body dementia

facts on parkinson’s

• how many people in the Netherlands

• men or women?

• onset

• what is it called to have an onset before age 50

• 58000 people in the Netherlands

• more prevalent in men

• onset is usually between 50-70

• young-onset Parkinson’s

what three stages of the disease are there?

1) preclinical

2) prodomal

3) clinical

explain the preclinical stage

neurodegeneration ahs begun, but there are no symptoms yet

e

explain the prodomal stage

symptoms that may be related to the disease appears

explain the clinical stage

motor symptoms appar, and a diagnosis is made

what are the four cardinal motor symptoms of Parkinson’s

1) bradykinea; slowing of movement

2) rigidity: stifness of the muscles

3) resting tremor; shaking or trembling of a limb at rest

4) postural instbaility: inability to balance due to loss of postural refleces

what subtypes belong to bradykinesia

akinesa; difficulty starting a movement

hypokinesia; lack of atuomatic movement and facial expression

gait freezing; inability to move feet forward

what subtypes belong to rigidity

micrographia; small writing

hypophonia; low voice volume

shuffling; small steps

what two subtypes can be distinguished based on motor symptoms

tremor - dominant subtype

postural instability and gait difficulty type

what is used to evaluate the clinical status of patients

MDS-UPDRS

what 4 parts does the MDS-UPDRS exist of

1) non-motor experiences of daily living

2) mtoor expereinces of daily living

3) motor examination

4) motor complication

what are risk factors of Parkinsons’s disease

aging, environmental factors, lifestyle factors, and genetic factors

where does degeneration occur

• explain what that is part of

in the dopamine-producing neurons in the pars compacta of the substantia nigra.

→ part of the cortico-basal-ganglia-thalamo-cortical circuit, which is important in regulating motor, cognitive and behavioural processes

Lewy bodies

abnormal deposits of accumulated portein called alpha-synuclein

what does the degeneration of thed opaminergic neurons affect

• give examples

non-motor symptoms; serotonergic (mood, sleep), noradrenergic (alertness, focus), and cholinergic (memory, learning) systems

when does a diagnosis of Parkinson’s disease happen

when motor symptoms occur, isnce there is no assessment that can make a definite diagnoses

what is the distinction between Parkinson’s and atypical parkinsonism based on

clinical symptomatology and the course of the disease

when will a diagnosis of atypical parkinsonism be considered

if motor symptoms don’t imporve after the use of Parkinson’s medication, or the diase has rapid progressoin, severe balance issues, or eye mvoement disorders

MSA

early autonomic disorders, speech and swallowing, cold and blue hands and feet, impaired trunk balance and severely stooped pressure

PSP

upright posture, disturbances in eye movement, disinhibition and emotional instability

CBD

heterogenous and asymmetrical symptoms; dystonia, difficulty controlling a limb

DLB

cognitive impairments, neuropsychiatric symptoms

→ hallucinations or cognitive impairments occur before the onset of motor symptoms

what is used to relieve the symptoms of Parkinson’s, and what does this do

medication, whcih targets the dopaminergic system

What are side effects of levodopa and dopamine antagonists

levodopa: nausea, sleepiness, hallucinations

dopamine antagonists; compulse disorders

what drugs are used to help with tremors, and what side effects do these drugs have

anticholnergic drugs

→ side effects: cognitive impiamrnet, confusion, hallucinations, fluctuations throughout the day

when effectiveness of medication decreases and response fluctuations arise, advanced therapies may be considered. Which are those?

DBS, LCIG, Subcutanceous administration of apomorphine, medications for non-motor symptoms, supportive care, CBT

Explain DBS

thin wire is implanted in the brain regions with abnormal signals, and hgih-frequency stimulation in those areas improves motor and non-motor symptoms

explain LCIG

gel is administered to the first part of the small intestince to offer continuous dopaminergic stimulation

why do the executive dysfunctions exist in mild cognitive impairment

due to degeneration of fronto-striatal areas

the cognitive profile of Parkinson’s isn’t strictly subcortical. Where is a more cortical profile and what does this affect

this is more posterior and affects memory, language, cisuospatial functions, and social cognition

Parkinson’s disease dementia

→ what is preserved and impaired in memory

apathy, anxiety, depression, and hallucinations, severy visuospatial impairments,

retention and recognition of information is preserved, but active retrieval of information is impaired

risk factors of Parkinson’s disease dementia

presence of MCI, older age, longer disease duration, severe motor symptoms, PIGD subtype and mood-related problems

PSP and CBD belong to the tau apathies and are both associated with language disorder. Explain for both if it has subcortical or cortical symptoms

PSP: more subcortical symptoms, with disinhibition already present in early stages of the disease

CBD; cortical disorder, and has a similar profile to FTD

Explain the 2 levels of diagnosis for MCI and Parkinson’s disease criteria as published by the MDS

level1: global cognitive screening by a treating specialist

level2: neuropsychological examination by an expert

what psychiatric symptoms are common in Parkinson’s disease

depression and anxiety

how many patients have depression, and what is teh cause

1/3 of patients and may be caused by disruptions in doapminergic circuits, as well as decreases in serotonin and norepinephrine

apathy

lack of interest, motivation and emotion, reduced goal-directed behaviour and decreased cogntive activity

impulse control disorders

impaired inhibitory control, inability to delay rewards, and icnreased need to seek thirlls wihtout regard to consequences

sterotyped behaviour

intense fascination with repetitive and excessive handling and examining of objects

dopamine dysregulation syndrome

increased need to dopaminergic medication

what may be present in Parkinson’s, and name the three exampels

impulsive compulsive behaviours:

→ impulse control disorders, stereotyped behaviour and dopamine dysregualtion syndrome