Movement Disorders Review Sheet

Question 1

average age of onset for Parkinson’s

Answer 1

58-60 years old

Question 2

PD is more often seen in which sex?

Answer 2

slightly more in men

Question 3

What is the cellular mechanism behind PD?

Answer 3

clumping of proteins (Lewy bodies) appear in neurons of the substania nigra, brainstem and other areas of the brain

degenerationa nd death of dopamine-producing neurons in the substania nigra

Question 4

What primary symptoms make up Step 1 of PD diganosis process

Answer 4

Tremor- resting
Rigidity
Akinesia or bradykinesia
Postural instability

Question 5

What exclusion criteria make up Step 2 of PD diagnosis process?

Answer 5

poor response to large doses of levodopa
symptomatic parkinsonism syndrome where symptoms appear to be related to some other cause such as exposure to toxins, head trauma, vascular, etc.
other neurodegenerative conditions in addition to PD type signs

Question 6

What are the features which support diagnosis of Step III?

Answer 6

unilateral onset
rest tremor (but one does not have to have this for diagnosis of PD)
excellent early response to levodopa
levodopa induced dyskinesias
progressive signs and symptoms, asymmetry of signs; at least initially
clinical onset > 10 years

Question 7

Bradykinesia

Answer 7

major sign of PD
slow movement
can’t realease thalamus enough to generate bugger bursts to create bigger movements

Question 8

Akinesia

Answer 8

major sign of PD
too much inhibition of the thalamus; can’t release it
masked facies (lack of expression) and reptilian stare (infrequent blinking)
arm swing decreased
difficulty stopping movement once started (festination)
difficulty stopping backwards movement (retropulsion)
“freezing” episodes

Question 9

What makes akinesia or bradykinesia worse?

Answer 9

dual tasking

Question 10

Rigidity

Answer 10

major sign of PD
increased resistance throughout the range
due to outputs to the pedunculopontine nuclei
-with a loss of dopamine, the pedunculopontine nucleus is inhibited so that it can no longer inhibit the reticulospinal and vestibulospinal tracts
-this leads to excitation of postural muscles
muscles are active even when the person is at rest
does NOT cause akinesia or bradykinesia

Question 11

Resting tremor

Answer 11

major sign of PD
rhythmic, alternating bursts of antagonistic muscles
due to different output pattern from BG
goes away with purposeful movement
“pill rolling” is the most common form
over 90% of those with a PD tremor have some degree of an action tremor

Question 12

Postural Instability

Answer 12

co-activation resulting in a rigid body and inability to recover stability

Question 13

What ANS problems occur with PD?

Answer 13

postural hypotension
excessive salivation and sweating
constipation and urinary disturbance

Question 14

What cranial nerve nucleus is involved with ANS problems

Answer 14

dorsal motor nucleus of X

Question 15

Mood and cognitive deficits of PD

Answer 15

• mild to moderate cognitive impairment
  
  • dysexecutive syndrome
• depression
• impulse control behavior disorder
• psychosis
• sleep disorders
• nutritional deficits
• speech

Question 16

What are the symptoms of dysexecutive syndrome?

Answer 16

impaired attention
verbal fluency reduced but language is preserved
visuospatial deficits
difficulty initiating planning and sequencing
impaired free recall
personality change

Question 17

What are the speech deficits of PD due to?

Answer 17

bradykinesia, akinesia and decreased chest excursion causes a decreased volume and slurred speech as the disease progresses

Question 18

what is forward festination?

Answer 18

inability to stop forward movement once it has started

bradykinesia issue; difficulty releasing thalamus to generate bigger bursts

Question 19

what is backward festination?

Answer 19

also called retropulsion
inability to stop backward movement
bradykinesia issue; difficulty releasing thalamus to generate bigger bursts

Question 20

Elements PT addresses in Parkinson’s

Answer 20

Gait
mobility deficits
Balance and falls
Loss of ROM/contracture/fixed, stooped posture
muscle atrophy and weakness
fatigue
cardiopulm deconditioning
osteoporosis
ulcers

Question 21

Gait of someone with PD

Answer 21

slow, shuffling and flat-footed
decreased arm swing
forward and backward festination
difficulty changing direction, going through doorways or over things which can trigger a freezing response

Question 22

main medication used for PD

Answer 22

Levodopa

Question 23

What are the major problems with this treatment?

Answer 23

• doesn’t help with tremors
• difficulty in delivery
• dual therapy with carbidopa has extreme side effects
• dyskinesias after prolonged use
• diminished response over time

Question 24

Advantages of dopamine agonists

Answer 24

effective as an early monotherapy
avoids levodopa side effects
has neuroprotective effects

Question 25

Disadvantages of dopamine agonists

Answer 25

less potent
long titration
requires levodopa addition eventually
cognitive side effects
confusion and hallucinations
\$\$$ expensive

Question 26

population for dopamine agonists

Answer 26

first line treatment for early PD in young, cognitively preserved patients

Question 27

population for carbidopa/levodpa

Answer 27

patients with more advanced PD that are older and more cognitively impaired

Question 28

Describe Chorea

Answer 28

Abrupt
Brief
Irregular
Purposeless
Unpredictable
Non-stereotypical
Involuntary movement

Question 29

when do the first symptoms of Huntingtons occur

Answer 29

onset at 35 and 42

Question 30

what NT are lost with huntingtons?

Answer 30

loss of Ach and GABA because there is too much dopamine and too much release of thalamus

Question 31

general development of huntingtons

Answer 31

first symptoms are mood/mental disorder with depression being the most common
then neurobehavioral changes
chorea

Question 32

what is a common sign of chorea?

Answer 32

milkmaids sign

increase and decrease in grip strength involuntarily

Question 33

what is hemiballismus

Answer 33

rotary nature/choreatic movements on one side of the body

caused by lesion of the subthalamic nucleus

Question 34

What causes tardive dyskinesia?

Answer 34

drug induced disorder secondary to use of antipsychotic drugs

Question 35

signs and symptoms of tardive dyskinesia

Answer 35

involuntary fragmented movements of the tongue, mouth and jaw
smacking, sucking noises
choreoathetoid movements
dystonia of neck and trunk

Question 36

characteristics of dystonia

Answer 36

PROLONGED muscle contractions of limbs/axial that are either repetitive or sustained

Question 37

what triggers dystonia

Answer 37

VOLUNTARY movement

Question 38

what worsens dystonia

Answer 38

fatigue and anxiety

Question 39

what is the most common type of dystonia

Answer 39

focal which includes task specific (writer’s cramp, musicicians) and spasmodic toricollis

Question 40

what is spasmodic torticollis

Answer 40

turning fo the neck that causes spasm

Question 41

how can spasmodic toritcollis be suppressed

Answer 41

only be self-touch sensory trick “gest”

Question 42

define a tic

Answer 42

major distinguishing characteristic is that if asked it can be suppressed
involves quick, involuntary movements that are repetitive at irregular intervals

Question 43

tourette’s syndrome

Answer 43

a simple or complex motor tic that may involve vocal tics(swearing)

Question 44

define myoclonus

Answer 44

quick muscle jerks, irregular or rhythmic that cannot be suppressed and result from cortical, cerebellar, brainstem or spinal cord disorders

Question 45

types of tremors

Answer 45

resting: rhythmic, alternating bursts of antagonistic muscles that goes away with purposeful movement
postural: type of action tremor that is not seen at rest

Intentional: type of action tremor where the closer you get to the target the wilder the movement; successive overshoots an undershoots about a goal that leads to oscillations