Summary clinical neuropsych.: NEUROPSYCHOLOGICAL ASPECTS OF PD

Neurospych. SWINNEN: NEUROPSYCHOLOGICAL
ASPECTS OF PD
INTRODUCTION
PARKINSON’S DISEASE IN A NUTSHELL

 James Parkinson (1755 – 1824)
- First to describe PD in his Essay on the Shaking Palsy (1817)
 focus on motor symptoms
 “intellect = unafflicted”
- 1980’s: non-motor symptoms addressed in research
- today: cognitive changes in PD acknowledged in clinical practice … but still underrecognized and
undertreated

 Chronic Progressive Degenerative Brain Disorder
- Fastest growing neurological disorder
- Second-most common neurodegenerative disorder
 First-most common = alzheimer
- Cause: degeneration dopamine-producing cells in substantia nigra of basal ganglia
- Effect: typical motor symptoms, non-motor features & neuropsychological
abnormalities
- Sinds 1990 incidentie x2
 Meest voorkomende neurodegeneratieve aandoening
- alzheimer

1. SYMPTOMS
 Rigidity
 Tremor
 Postural instability & balance disorders
 Bradykinesia
 Freezing of gait
 Shuffling and propulsive gait, …
 Recognisable motor symptoms of PD = Tip of the iceberg...




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, Neurospych. SWINNEN: NEUROPSYCHOLOGICAL
ASPECTS OF PD

2. NON-MOTOR DISORDERS
Neuropsychiatric symptoms: Gastrointestinal symptoms:
- Depression, apathy - Dribbling of saliva
- Anxiety - Dysphagia (difficulty swallowing)
- Cognitive impairment - Reflux
- Executive dysfunction - Constipation
- Attention deficits - Fecal incontinence
- Hallucinations, delusions Autonomic symptoms:
- Dementia - Bladder disturbances (urgency, nocturia,
- Impulsive & compulsive behavior frequency)
 Sleep disorders: - Excessive sweating
- Restless legs - Orthostatic hypotension
- Excessive daytime somnolence - Erectile impotence

 niet allemaal even duidelijk voor het blote oog
 Sommige symptomen doen zich ook ivoor bij verouderen
- Niet perse gezien als gevolg PD


THE FRONTOSTRIATAL NETWORK

1. EVOLUTIONARY INTERPRETATION
 Organisms are in need of two systems for behavioral control:
- 1. Routine responses to known environmental stimuli: pre-programmed behavior, stimulus- based,
procedural, automatic
 BASAL GANGLIA
 Vb:wandelen
- 2. Reflective, problem-solving behavior in new situations
 FRONTAL CORTEX
 Vb:leren autorijden
 these two systems are integrated in the FRONTOSTRIATAL NETWORK
- striataal= basale ganglia
 Learning how to drive a car recuirs a lot of attention in the beginning (frontal)

2. LOOPS BETWEEN CORTEX – BASAL GANGLIA – THALAMUS – CORTEX
 Loop starts at the cortex goes to the BG (upper and
lower nuclei), to the thalamus and then back to the
cortex
 Eerste 5(van links te beginnen)
- Frontale cortex input nuclei basale
gangliathalamusterug naar frontale cortex




3. 3 LOOP SYSTEMS
 1 manier van onderverdelen
 Deficits in these circuits will cause problems in motor,
cognition and emotions
 Manier om het fronto-striataal network te
onderscheiden
 Basale ganglia spelt in alle 3 een cruciale rol
- Motor symptoms
- Cognitieve problemen
- Emotionele problemen

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