Book contents
- Frontmatter
- Contents
- Contributors
- Foreword
- Acknowledgements
- Biographical note on F. H. Lewy
- Abbreviations
- Group photograph
- Introduction
- Part one Clinical issues
- Part two Pathological issues
- Part three Treatment issues
- 28 Psychopharmacology of cognitive impairment in Parkinson's disease
- 29 Management of the noncognitive symptoms of Lewy body dementia
- 30 Altered consciousness and transmitter signalling in Lewy body dementia
- 31 Cholinergic therapy and Lewy body dementia
- 32 Clinical heterogeneity in dementia: responders to cholinergic therapy
- 33 Tacrine and symptomatic treatment in Lewy body dementia
- 34 Neurochemical correlates of pathological and iatrogenic extrapyramidal symptoms
- 35 Neurotrophins and the cholinergic system in dementia
- 36 Relevance of Lewy bodies to alterations in oxidative stress in Lewy body dementia and Parkinson's disease
- Résumé of treatment workshop sessions
- Appendices
- Index
- Plate section
34 - Neurochemical correlates of pathological and iatrogenic extrapyramidal symptoms
from Part three - Treatment issues
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- Contributors
- Foreword
- Acknowledgements
- Biographical note on F. H. Lewy
- Abbreviations
- Group photograph
- Introduction
- Part one Clinical issues
- Part two Pathological issues
- Part three Treatment issues
- 28 Psychopharmacology of cognitive impairment in Parkinson's disease
- 29 Management of the noncognitive symptoms of Lewy body dementia
- 30 Altered consciousness and transmitter signalling in Lewy body dementia
- 31 Cholinergic therapy and Lewy body dementia
- 32 Clinical heterogeneity in dementia: responders to cholinergic therapy
- 33 Tacrine and symptomatic treatment in Lewy body dementia
- 34 Neurochemical correlates of pathological and iatrogenic extrapyramidal symptoms
- 35 Neurotrophins and the cholinergic system in dementia
- 36 Relevance of Lewy bodies to alterations in oxidative stress in Lewy body dementia and Parkinson's disease
- Résumé of treatment workshop sessions
- Appendices
- Index
- Plate section
Summary
Summary
Several aspects of movement control by neuronal pathways in the basal ganglia are summarized. Evidence from neurochemical analyses in various neurodegenerative disorders is presented to demonstrate that a severe loss of dopamine in the putamen does not of itself represent a necessary condition for the appearance of extrapyramidal symptoms, and that the appearance of extrapyramidal symptoms or sensitivity to antipsychotics eliciting extrapyramidal symptoms is not solely dependent on a lack of striatal dopamine. The strategies of reduction of cholinergic activity and of reduction of the firing rate of the serotonergic neurons are alternatives to the traditional dopamine replacement therapy in the management of extrapyramidal symptoms. Inhibition of dopaminergic activity by dopamine D2 receptor blockers, as a means of controlling psychotic symptoms is considered inappropriate in disorders such as Lewy body dementia with a potential for increased sensitivity to such medication.
Introduction
The major extrapyramidal features of resting tremor, cogwheel rigidity, akinesia and disturbance of posture are most commonly regarded as clinical symptoms of Parkinson's disease (PD), and neurochemically are associated with lesions of the dopaminergic projections to the corpus striatum from the zona compacta of the substantia nigra. However, these abnormal motor movements also occur in Lewy body dementia (LBD) and in other categories of patients, examples of which are listed in Table 34.1.
In considering these disorders, the questions under discussion are whether extrapyramidal features are always a result of loss of dopaminergic neurotransmission and, if not, what neurochemical environment is responsible for the absence or presence of parkinsonian symptoms in patients with variable losses of nigrostriatal dopaminergic function.
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- Dementia with Lewy BodiesClinical, Pathological, and Treatment Issues, pp. 449 - 467Publisher: Cambridge University PressPrint publication year: 1996
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