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• 1 Lecture 5 Subcortical dementia

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• Which subcortical areas are involved in executive dysfunction?

  - Dorsolateral prefrontal cortex
  - Caudate nucleus
  - Globus pallidus
  - Thalamus

• Which subcortical areas are involved in apathy?

  - Medial frontal cortex
  - Nucleus accumbens
  - Globus pallidus
  - Thalamus

• What are risk factors for Parkinson's?

  Age, male gender
  Genes: two rare dominant mutations and several recessive mutations

• What are non-motor symptoms occuring in Parkinson's?

  - Olfactory dysfunction
  - Changes in personality and mood
  - Excessive daytime sleepiness
  - Autonomic dysfunction
  - Psychotic symptoms (visual hallucinations)
  - Pain
  - Cognitive impairment
  - Demantia (30-70%)

• How is Parkinson's diagnosed post-mortem?

  - Depigmentation of the substantia nigra
  - Lewy bodies in the brain stem

• Which neurotransmitter systems are involved in Parkinson's?

  - Dopaminergic system
  - Noradrenergic system
  - Serotonergic system
  - Cholinergic system

• What are clinical substypes of Parkinson's and what characterizes them?

  - Termor-dominant: mild disease progression
  - Akinetic-rigid: more severe cognitive impairment
  - Postural instability and gait difficulty: cognitive impairment and severe disease progression

• What is found in NPA in Parkinson's?

  - Executive functioning: difficulties in initiation, planning, concept formation, rule finding, set-shifting, and attention. Bradyphrenia (slowing)
  - Memory: retrieval inefficiencies, but relative intact recognition
  - Micrographia

• What are the core criteria for the diagnosis Parkinson's Disease Dementia?

  - Diagnosis of Parkinson's
  - Dementia syndrome with insidious onset and slow progression: more than 1 cognitive domain affected, decline from premorbid level, impairment in daily life.

• What are associated clinical features in the diagnosis of Parkinson's Disease Dementia?

  Cognitive:
  - Attention: fluctuating, spontaneous and focussed
  - EF: planning, concept formation, rule finding, set shifting and maintenance, mental speed
  - Visuospatial: orientation, perception, construction
  - Memory: free recall less than recognition
  - Language: preserved, some word finding difficulties
  Behavior:
  - Apathy, hallucinations, delusions, sleepiness, change in personality and mood