Parkinsons Disease PD

PD is primarily a progressive, extrapyramidal (involving motor systems ofthe basal ganglia rather than the pyramidal tract) disorder with clinical motor features of stooped posture, bradykinesia (slowing of movement initiation), tremor (when the affected limb is at rest, but typically not during movement), cogwheel rigidity (i.e., rigidity that seems to catch and release, much like a cogwheel, when the clinician attempts to passively move the patient's limb), and festinating gait. Dementia has been estimated to occur in approximately 35-40% of persons with PD. The neuropsy-chological impairments manifested in the dementia of PD include psychomotor slowing, impaired cognitive tracking and set-shifting flexibility, visuospatial deficits, diminished learning and retrieval (although, as with HD, often there is evidence of more intact information retention shown by recognition memory tasks), decreased verbal fluency, and abstract reasoning impairment. Neuronal degeneration (with Lewy bodies; see later discussion) occurs primarily in pigmented cells of the substantia nigra (particularly the pars compacta region) and other brain stem structures (e.g., locus ceruleus, dorsal vagal nucleus). The substantia nigra degeneration causes a severe reduction in dopamine neurotransmitter projections to the striatum, responsible for the observed extrapyramidal motor disorder and contributing to the cognitive impairments.

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