Parkinson's Disease Overview Quiz

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Questions and Answers

What age group is most commonly affected by atherosclerosis?

Over 60 years (correct)

40-60 years

30-40 years

Under 30 years

Which symptom is NOT considered a cardinal symptom of Parkinson disease?

Rigidity

Postural Instability

Hypertension (correct)

Tremors

What type of tremor is most commonly seen in Parkinson disease?

Essential tremor

Action tremor

Resting tremor (correct)

Psychogenic tremor

What is the main characteristic of rigidity in Parkinson disease?

Involuntary increase in muscle tone Signup and view all the answers

Which of the following symptoms increases with emotional stress in Parkinson disease?

Tremors Signup and view all the answers

What does the term 'cog-wheel rigidity' refer to in Parkinson disease?

Intermittent resistance interrupted by tremors Signup and view all the answers

What does the term 'bradykinesia' mean in the context of Parkinson disease?

Slowness of movement Signup and view all the answers

In which condition is paralysis most likely to occur?

Post-encephalitic Signup and view all the answers

What is one of the primary functions of the extrapyramidal system?

Maintenance of emotional movements Signup and view all the answers

Which area is the origin of the neural pathway leading to the corpus striatum?

Area 6 Signup and view all the answers

What type of tremor is most associated with Parkinsonism?

Static and rhythmic Signup and view all the answers

What is the effect of emotional stress on tremors associated with extrapyramidal disturbances?

Increase in tremor intensity Signup and view all the answers

What is a characteristic feature of bradykinesia in patients with Parkinsonism?

Loss of facial expressions Signup and view all the answers

Disturbance in which extrapyramidal function leads to hypertonia as described in the content?

Maintenance of normal muscle tone Signup and view all the answers

Which part of the brain do the fibers from the globus pallidus pass to?

Various nuclei including the red nucleus Signup and view all the answers

Which condition is characterized by rhythmic, regular tremors that increase with stress?

Parkinsonism Signup and view all the answers

Which of the following strategies is NOT a method for preventing falls?

Breathing techniques Signup and view all the answers

What is a primary goal of EMG biofeedback in motor control?

To improve motor control through real-time feedback Signup and view all the answers

Which activity is specifically included in gait training strategies?

Treadmill training Signup and view all the answers

How can family involvement assist in the treatment of depression in patients?

By accompanying the patient in daily activities Signup and view all the answers

Which technique is NOT part of functional activity training to overcome falling?

In-home cooking classes Signup and view all the answers

Which of the following are components of the basal ganglia?

Subthalamic nucleus Signup and view all the answers

What is the function of the substantia nigra?

Motor learning Signup and view all the answers

The brain reward system is activated by which of the following?

Dopamine release during pleasurable activities Signup and view all the answers

What distinguishes the two parts of the substantia nigra?

Functional roles and connections Signup and view all the answers

What happens to the brain when drugs are consumed?

They cause a surge of dopamine release Signup and view all the answers

One of the main functions of the basal ganglia is to control which of the following?

Voluntary motor movements Signup and view all the answers

What impact does addiction have on the brain's response to drugs over time?

The brain becomes desensitized to dopamine Signup and view all the answers

Which neurotransmitter is primarily associated with feelings of pleasure in the brain?

Dopamine Signup and view all the answers

Which of the following is NOT a technique used to address Orofacial dysfunction?

Serial casting Signup and view all the answers

What is a recommended strategy for managing rigidity in patients?

Sensory reinforcement Signup and view all the answers

What does a score of 3 indicate regarding tremor severity?

Marked tremor, writing and drawing spiral illegible Signup and view all the answers

Which method is effective in controlling tremors?

Weighting added to specific body parts Signup and view all the answers

When addressing bradykinesia, what is a crucial step to help the patient transition from supine to sitting?

Breaking down complex tasks into sub-tasks Signup and view all the answers

Which assessment technique involves checking muscle tone?

Palpation Signup and view all the answers

Which of the following techniques is used in cardiopulmonary training strategies?

Breathing exercises with upper limb movement Signup and view all the answers

Which of the following symptoms is NOT indicative of advanced Parkinsonism?

Mild tremors during writing Signup and view all the answers

What is an appropriate treatment option for Parkinsonism?

Levo-Dopa Signup and view all the answers

What is a common approach to alleviate restless leg syndrome?

Daily walking or stretching Signup and view all the answers

Which strategy can be used to improve balance and prevent falls?

Sequential motor task training Signup and view all the answers

Which factor is assessed during the mental examination in Parkinsonism?

Cognitive function Signup and view all the answers

Hyporeflexia in Parkinsonism may be associated with which condition?

Rigidity Signup and view all the answers

Which intervention is specifically aimed at managing tremors?

Weighting limbs Signup and view all the answers

What describes the posture often observed in patients with Parkinsonism?

Flexion attitude Signup and view all the answers

What is the primary goal of the 'Examination of Bradykinesia'?

To evaluate the speed of movement Signup and view all the answers

Study Notes

Parkinsonism (Parkinson Disease)

Tremors are a persistent symptom, even at rest.
Shuffling gait, characterized by small, uneven steps, and an unbalanced posture.
Parkinsonism, or Parkinson's disease (PD), is a chronic, progressive neurodegenerative disease.
Decreased dopamine production in the substantia nigra is linked to the disease.
Most cases of Parkinson's disease are idiopathic, meaning the cause is unknown.

Extrapyramidal Tracts

Originates from areas 6 and 4 of the brain.
Descends to the corpus striatum, part of the basal ganglia.
Then to the globus pallidus, also part of the basal ganglia.
Fibers from the globus pallidus then project to the reticular formation, vestibular nuclei, red nucleus, and tectum of the midbrain.
These nuclei are involved in extrapyramidal tracts.

Components of Basal Ganglia

The basal ganglia include the caudate nucleus, putamen, and globus pallidus (with external and internal segments).
The subthalamic nucleus and substantia nigra are also functionally related to the basal ganglia.
The amygdala, located in the temporal lobe has similar embryonic origins but is functionally part of the limbic system.

Functions of the Extrapyramidal System

Regulates and integrates voluntary motor activity
Regulates and maintains muscle tone
Regulates and maintains emotional and associative movements

Disturbances of the Extrapyramidal System

Leads to disturbances in voluntary motor activity, resulting in static tremors.
Tremors can be rhythmic (Parkinsonism) or dysrhythmic (chorea, athetosis, dystonia).
Tremors generally worsen with anxiety, stress, and fatigue and improve during sleep and voluntary movement.
Result in hypertonia, commonly described as rigidity.
Leads to bradykinesia, resulting in a mask-like face (lack of expression) and a decrease in arm swing during walking.

Basal Ganglia

A group of subcortical nuclei located at the base of the forebrain and top of the midbrain.
These nuclei have varied origins.
The main components are the striatum (dorsal and ventral), globus pallidus, ventral pallidum, subthalamic nucleus, and substantia nigra.

Substantia Nigra

A basal ganglia structure located in the midbrain.
The name literally translates to "black substance," due to its appearance from the high levels of neuromelanin in the dopaminergic neurons.
Composed of two components (pars compacta and pars reticulata), each with distinct connections and functions.
Plays a critical role in eye movement, motor planning, motor learning, reward, and addiction.

Dopamine Neurotransmitter

A neurotransmitter involved in the brain's reward system, which regulates feelings of pleasure.
Released in response to pleasurable activities, such as eating delicious food and falling in love.
Drugs mimic the brain's reward system by producing a similar surge in dopamine, leading to a potentially potent "pleasure effect," which can be longer-lasting than natural highs, and motivate continued use, which can result in addiction.

Parkinson's Disease (Idiopathic)

A chronic, progressive neurodegenerative disease.
Due to the degeneration of pigmented cells (neuromelanin) in the substantia nigra pars compacta, leading to dopamine deficiency affecting the brain.
Characterized by a gradual onset occurring usually after the age of 50.
Men and women are equally affected.

Parkinson's Disease (Symptomatic)

Parkinsonism with a known cause, without changes in basal ganglia or substantia nigra.
Inflammatory (encephalitis), Vascular (cerebral atherosclerosis), Toxic, Neoplastic (tumors of basal ganglia), and Traumatic (repeated head trauma.

Common Causes of Parkinsonism

Paralysis agitans, Post-encephalitic, and Atherosclerosis.

Cardinal Symptoms of Parkinson's Disease

Tremors, Rigidity, Slowness of movement (bradykinesia/akinesia-kinesia paradoxica), and Postural instability

Secondary Motor Manifestations of Parkinson's Disease

Freezing, Micrographia, Loss of emotional and associative movements, Immobile face, Monotonous speech, Loss of arm swing, Unwanted accelerations, Impaired motor dexterity, Impaired motor coordination, Akathisia, Speech and swallowing disturbance, Hypophonia, Monotonic speech and Drooling Dysphasia.

Gait and Posture Disturbances in Parkinson's Disease

Slow gait, Short step, Shuffling gait, Festination (increased walking speed), Decreased arm-swing, Turning "en bloc," and Stooped forward-flexed posture.

Diagnosis of Parkinsonism (Parkinson's Disease)

Clinical Rating Scales (UPDRS) are used in clinical assessments of Parkinsonism.
The UPDRS includes four subscales: 1 (mentation, behavior, mood), 2 (daily activities), 3 (motor assessment), and 4 (therapy complications).
Data for subscales 1, 2, and 4 is elicited from patients and caregivers, while data for subscale 3 is examination-based.

Yahr Classification of Parkinsonism Stages

I: Minimal or absent, unilateral symptoms if present.
II: Minimal bilateral or midline involvement, balance is not impaired.
III: Impaired righting reflexes/unsteadiness when turning/rising from chair; some activities are restricted but independent living is possible.
IV: All symptoms present and severe. Some daily living activities require assistance.
V: Confined to bed or wheelchair unless aided.

Medical Treatment of Parkinsonism

Levodopa, Levodopa + Carbidopa, Dopamine agonists, Anticholinergic drugs, and Amantadine hydrochloride.

Assessment of Parkinson's Disease by Inspection

Involuntary movements (tremors), Skeletal deformities, and Posture (flexion attitude).

Tremor Assessment

0: No tremor.
1: Mild tremor, minimal impairment of writing, drawing and daily activities.
2: Moderate tremor, moderate impairment in some activities
3: Significant tremor, severe impairment in activities
4: Severe tremor, extensive functional limitations.

Skeletal Deformities Assessment

Stooped posture, flexed elbows & wrists, tremors of extremities.

Motor Assessment by Palpation

Muscle tone (rigidity), Muscle strength, A- and B-functional muscle testing, Postural reactions, Balance examination, and Joint ROM, Sensation (pain), Coordination testing, Functional examination, and Examination of bradykinesia.

Examination of Muscles Tone & Reflexes

Hypertonia, Hyporeflexia (deep reflexes may be reduced).

Management of Parkinson's Disease

Orofacial dysfunction, Rigidity, Bradykinesia, Tremors, Cardiopulmonary training, Restless Leg Syndrome, Balance and Posture problems, Gait training strategies, EMG Biofeedback, Icing, Functional activities, Depression, and Role of family.

Additional Information

The images provided illustrate examples of the symptoms and conditions associated with Parkinson's disease.
There are different aspects of this disease (pathophysiology, symptoms, diagnosis, and treatment) and management procedures.

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Description

Test your knowledge on Parkinson's disease, including its symptoms, characteristics, and the impact of emotional stress on patients. This quiz covers key concepts and terms like bradykinesia and cog-wheel rigidity to enhance your understanding of this condition.