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Parkinson's Disease - Coggle Diagram

- - - - Protofibrils, a toxic species that mediates disruption of cellular homeostasis and neuronal death
    - - Reduced number of vesicles available for dopamine storage
  - - - Seborrheic dermatitis
        
        Over-secretion of oils from sebaceous glands
      - Hyperhidrosis
        
        Activates sweat secretion
        
        Inability to regulate body temperature
      - Inhibits peristalsis
      - Cardiac sympathetic denervation
        
        Neurogenic orthostatic hypotension
      - Bladder dysfunction
  - - - Involved in calcium homeostasiss
      - Organelle biogensis
      - Loss of ATP13A2, a P-type ATPase is associated with increased oxygen consumption and increased ROS production
    - - Activated microglia
        
        A source of superoxide and nitric oxide, which in turn contribute to oxidative and nitrative stress in the brain microenvironment.
- - - - Are progressive, initially manifesting in an isolated area and often beginning in one hand.
  - - - Hypomimia
      - Abnormal flexed posture
    - - Lingual bradykinesia
      - Oropharyngeal dysphagia
      - Upper esophageal dysmotility
  - - - Decreased frequency of blinking, staring
  - - - Lack of coordination in the vocal musculature
  - - - Primarily on the scalm and sides of the nose
- - - - Hypomimia, causing altered communication.
  - - - Olfactory hypofunction
        
        Decreased smell
        
        Affecting taste of food
  - - - Swinging arms when walking
      - Blinking
      - Failure of basal ganglia output to reinforce cortical mechanisms that prepare and execute commands to move
  - - - Impaired intra-oral salivary clearance
  - - - Hearing things that others do not
        
        Voices
        
        Music
        
        Conversations
      - Paranoia
        
        Believing people are talking about you or trying to access your money
      - Seeing things that others do not
        
        People
        
        Objects
        
        Animals
      - False beliefs
        
        Fears loved ones are stealing from you, putting in harms way, or being unfaithful
- - - - Stoma creation for PEG-J tube placement into small intestines
        
        Combination of carbidopa and levodopa dosed through enteral suspension
    - - Surgery 1: Electrodes are inserted using MRI. Recordings of brain cell activity during procedure
        
        Surgery 2: IPG (impule generator battery) implantation providing electrical impulse
        
        Globus pallidus
        
        Neuromodulation
        
        Effective for refractory axial signs and dyskinesia
        
        Ventral intermediate nucleus of the thalamus
        
        Effective for medically refractory essential tremor and tremor-dominant Parkinson’s disease.
        
        Subthalamic nucleus
        
        Effective for all major movement including tremor, bradykindesia, rigidity, balance, and gait
  - - - Mirapex
      - Mirapex ER
      - Requip
      - Requip XL
      - Apokyn
      - Neupro
    - - Eldepryl
      - Zelapar
      - Azilect
      - Xadago
    - - Sinemet CR
      - Parcopa
      - Sinemet
      - Rytary
      - Duopa
    - - Comtan
      - Tasmar
    - - Block acetylcholine
        
        Artane
        
        Cogentin
    - - Gocovri
      - Symmetrel
      - Osmolex
    - - Inbrija
    - - Stalevo
    - - Nourianz
  - - - LSVT BIG
        
        Evidence-based strategies for learning and neuroplasticity
        
        Improves small and large motor tasks
      - LSVT LOUD
        
        Tailored exercises that strengthen larynx and speech system
        
        increasing vocal loudness and delivering the treatment in an intensive, high-effort manner
        
        improves communication through articulation, intonation, and facial expression