Cerebrovascular disorders

Parkinson's Disease

• Cardinal triad: rest tremor, cog-wheel rigidity, bradykinesia.
• Common psychiatric issues include cognitive impairment, depression, psychosis, and behavioral problems.
• Impaired olfaction can be an early indicator, occurring years before motor symptoms.
• Common non-motor symptoms: constipation, sleep disturbances.
• Diagnosis of dementia in Parkinson’s occurs when cognitive decline starts more than a year after motor symptoms onset.
• Synaptic dysfunction, oxidative stress, and neuroinflammation play roles in disease etiology.

Dementia in Parkinson's Disease

• Approximately 30% prevalence of cognitive impairment; up to 80% may develop dementia.
• Dementia types:
  • Parkinson's disease dementia: develops >1 year after motor onset.
  • Dementia with Lewy bodies: develops <1 year after motor onset.
• More prevalent in later-onset cases and when bradykinesia predominates.

Depression and Parkinson’s Disease

• Up to 35% of patients exhibit clinically significant depressive symptoms.
• Depression commonly occurs in early and advanced stages.
• Correlation between depression and frontal lobe abnormalities or disturbed dopaminergic mechanisms.

Tourette Syndrome

• Symptoms include overactivity, learning difficulties, emotional disturbances, and social issues.
• Common comorbidities: ADHD and obsessive-compulsive disorder (OCD), with over 50% having one.
• Prevalence: 0.5-1% in children, more common in males (3-4 times).
• Genetic link, with environmental factors like prenatal smoking and hypoxia being implicated.

Treatment and Outcome of Tourette Syndrome

• Mild cases may not require treatment; mild and behavioral interventions are primary methods.
• Effective management strategies include addressing comorbid psychiatric issues.
• Outcomes suggest two-thirds of patients improve or have lasting remission into early adulthood.

Psychiatric Manifestations in Parkinson's Disease

• Manifestations can include delirium, cognitive decline, depression, hallucinations, delusions, and sleep disorders.
• Visual hallucinations (20% occurrence) often linked to dopaminergic medication and related factors.
• Treatment considerations: using SSRIs cautiously to avoid cognitive impairment exacerbation.

Huntington's Disease

• Autosomal dominant disorder from expansion of CAG repeats in the HTT gene on chromosome 4.
• Greater than 40 CAG repeats lead to full penetrance.
• Anticipation phenomenon: earlier onset in subsequent generations.
• Cognitive impairment features: cognitive slowing, reduced attention, and poor emotional recognition.

Neuropathology of Huntington's Disease

• Primary atrophy affects the caudate nucleus and frontal lobes.
• MRI reveals caudate shrinkage correlating with motor and cognitive deficits.
• Presence of polyglutamine nuclear inclusions associated with HTT gene mutation.

Dystonias

• Uncontrolled focal muscle spasms lead to involuntary movements.
• Etiology varies including genetic mutations, infections, neurotoxicity, and drugs.
• Clinical examples: blepharospasm, torticollis, writer's cramp.
• Botulinum toxin injections are most effective treatment.

Tics

• Stereotyped movements prevalent in children, often triggered by emotional disturbances.
• Treatment includes behavioral interventions, exposure prevention, and occasionally atypical antipsychotics.
• 80-90% of childhood tics improve within 5 years, with common associations to OCD, ADHD, and anxiety disorders.

Risk Factors for Parkinson's Disease

• Genetic: mutations in genes like SCNA, LRRK2, GBA are significant.
• Environmental: pesticide exposure, head injury, rural living increase risks.
• Protective factors include coffee consumption and tobacco smoking.

Motor and Cognitive Features of Huntington's Disease

• Motor abnormalities: chorea, impaired voluntary movements, and bradykinesia.
• Cognitive impairment includes attention deficits and reduced planning abilities.
• Behavioral features range from depression to early loss of insight.

This quiz explores key aspects of Parkinson's disease, including its cardinal triad of symptoms, common psychiatric issues, and non-motor symptoms. Furthermore, it delves into the prevalence and types of dementia associated with Parkinson's, as well as the impact of depression on patients. Test your understanding of this complex neurodegenerative condition.