PARKINSON’S WEEK

QUIZ TIME!

Wooooo!

Give me 3 causes of gait abnormality: Parkinson’s disease, Huntington’s disease, Parkinson plus

syndromes: Multiple System Atrophy, Lewy Body Dementia, (each of these can produce a short shuffling Parkinson’s gait

Huntington’s is more commonly characterised by chorea (brief, purposeless jerky movements)

Multiple Sclerosis (tends to be ataxic) Degenerative back, hip and knee joint diseases Trauma (foot, knee, hip, back, head) CVA, multi infarct dementia Infective: encephalitis, meningitis, syphilis Ataxia (ataxic gait) due to ethanol, drugs (eg antiepileptics),

B12 deficiency, renal failure, sensory ataxia due to spinal lesion or peripheral neuropathy (diabetes), hyper/hypo natremia, hypercalcaemia, cerebellar lesion eg following stroke.

Congenital brain abnormality

Parkinson’s Disease List one protective and one risk factor for

developing Parkinson’s DiseaseNicotine Genetics

What macroscopic change is evident in this disease?Pallor of the substantia nigra

State the pathophysiology behind the diseaseDegen of dopaminergic neurons ↓ striatal

dopamine (putamen responsible for motor) Imbalance of Ach and Dopamine

Parkinson’s Disease How is it diagnosed?

Clinical Diagnosis: Must include resting tremor, cogwheel rigidity, bradykinesia/ akinesia and impaired posture. Rule out other causes

What are Parkinson Plus Syndromes?Disorders in which there is parkinsonism plus

additional features and specific pathology Describe how Levodopa and Carbidopa work

Carbidopa – peripheral dopa decaboxylase inhibitor. ↓ req. dose by 10x. Don’t penetrate BBB. Allows levodopa to diffuse across without being decarboxylated

Levodopa – Crosses BBB. Decarboxylated into exogenous dopamine floods the synapse

Multiple Sclerosis What is optic neuritis

Inflammation of the optic nerve. Sx. due to loss of myelin sheath or, rarely, damage to the axon

What brain matter does MS effect?White

What defines MSAutoimmune demyelinating disorder characterised by

distinct episodes of neurological deficits (separated in time) attributable to white matter lesions (separated in space)

symptoms must last for > 24 hr and occur as distinct episodes that are separated by a month or more

Multiple Sclerosis What are the two main causes of death

associated with MSUraemia and Bronchopneumonia

Describe the most common course of MSRelapsing/remitting MS: discrete attacks that

evolve over wks-mths. Complete recovery b/n events. If severe (ambulatory) 50%

State some management options for MSEducation, rehab, social support, home

support…. Do steroids have a place in management?

Can reduce severity in relapse. No long-term diff

Alzheimer Disease State the aetiological difference between delirium and

dementia Delirium – disturbed CNS functioning Dementia – Structural CNS pathology

What is the DSM IV criteria for dementia A1 – memory impairment A2 - ≥1 cognitive disturbance (aphasia, apraxia, agnosia,

executive functioning) B – Disturbances significantly interfere with social and work

functions C – Gradual onset and continuing cognitive decline D – Not due to a known organic cause (drugs, illness, CVA) E – Not a delirium F – Not due to another Axis 1 Disorder (eg depression)

Alzheimer Disease How is AD diagnosed?

Diagnosis is made on clinical assessment and supported by investigation results.

State 3 causes of dementia degenerative cerebral diseases, including

○ Alzheimer's disease (about 60%)○ dementia of frontal type (up to 10%)○ dementia with Lewy bodies (up to 10%)

vascular (15%) alcohol excess (5%) AIDS dementia cerebral tumours Cruetzfeldt-Jakob disease Pick's disease neurosyphilis

Alzheimer Disease Which three secretases break down APP,

and which is the troublesome one?α, β and γ. β is the troublesome one

What two elements are involved in the pathogenesis of AD?Aβ peptides which are insoluble and neurotoxic

and lead to plaque formation and inflammationTau protein dysfunction axon tangles

What changes in the brain are observed in AD?Atrophy of the cerebrum, firstly the amygdala

and hippocampus.

Huntington’s Disease What inheritable genetic type is HD? So if

both parents have one gene each for the disease, what chance do their kids have of developing it?Autosomal dominant. 75%

What macroscopic changes are seen in HD?Atrophy of the caudate nucleus and the putamen

How does this explain the Sx of HD?Basal ganglia circuitry dampen (to modulate)

motor output. Atrophy ↑ motor output choreaDementia probably due to atrophy of the cortex.

Huntington’s Disease Please provide me with a 3D sketch of the

caudate nucleus and the putamen, explaining their Function.

While you’re at it, do the same for the mammilary bodies

What protein is thought to be involved in the pathogenesis of HD? Function?Huntingtin – unknown function

What Tx. is available for HDNone adequate. Psychosocial, dopamine blocking

agents (SE), antidepressants/ anxiety drugs Likely cause of death

Infection, suicide

Verbally go through a…. Cranial Nerve Exam

I - XII Upper an lower limb neuro exam

Position/Function TestsInspectToneStrength/PowerReflexCo-ordinationSensation (Soft, pain, vibration, proprioception)