1. Parkinson’s Disease storyboard

2. Possible Intro Scenario As an resident at Normal Hospital, you are beginning your rotation in neurology. Your supervisor, Dr. _____, mentions that one of the patients coming in today, ________, suffers from Parkinson’s Disease. She recommends that you familiarize yourself with disease, including the cause, symptoms, and latest research. She informs you that the hospital’s electronic medical reference will contain everything you need to get started and suggests that proceed to the ________ room to explore the EMR on the computer there. Student then proceeds to the room mentioned above.

3. Once at the computer in the _____ room… Student clicks the computer on and is greeted with the similar menu as the stroke lab, including the Parkinson’s Disease tutorial, EMR, lab notebook, and protocol. The Parkinson’s Disease tutorial should include the following items… –Symptoms of PKDSymptoms of PKD –Dopamine in the brainDopamine in the brain –Neuron transmissionNeuron transmission –Dopamine tone and Parkinson’s DiseaseDopamine tone and Parkinson’s Disease –Maintenance of Dopamine ToneMaintenance of Dopamine Tone –Research in Parkinson’s DiseaseResearch in Parkinson’s Disease –The Bucket TheoryThe Bucket Theory

4. Remaining Issues Need to figure out computer screen format for tutorial. Need to figure out what needs to go in the EMR. Need to determine if questions will be multiple choice or free form. Need to determine what will go in the electronic lab notes. Need to determine how deep to get into brain anatomy. Need to figure out questions/activity for the Bucket theory and computer program animations. Need to determine how to transition from human brain to rat brain. Need to figure out final product.

5. Symptoms of PKD Students watch a video of a PKD patient and are asked to check off the symptoms they see. Once they correctly answer the checklist, the symptoms should go in their lab notes (electronically). Symptoms should include… –Tremor –Bradykinesia (slowed motion) –Rigid muscles –Impaired posture/balance –Loss of automatic motions

6. Additional Symptoms There are symptoms that students can not observe from the video. These include speech changes and dementia. These two symptoms should be mentioned at some point in time. Perhaps they could be added after the checklist such as in the following statement? Well done! You’ve identified all of the observable characteristics of Parkinson’s Disease. Please realize that patients suffering from Parkinson’s Disease will also often exhibit speech changes and dementia.

7. Dopamine in the Brain Parkinson’s Disease is caused by the loss of dopamine neurons in the substantia nigra of the brain. These dopamine neurons originate in the substantia nigra and terminate in the striatum, where they release dopamine to activate different activities. Proceed to the activity

8. Dopamine in the brain Activity Click on the brain below to see what areas of the brain dopamine affects. Students are then either asked to list these areas of the brain or choose from a checklist. Students could then match the PKD symptoms to the brain areas they think they control. Again there could be a “check your answer” section (similar to the EMR).

9. Dopamine Pathway in the Brain Dopaminergic pathways of the human brain in normal condition (left) and Parkinson's disease (right). Red Arrows indicate suppression of the target, blue arrows indicate stimulation of target structure.

10. Another look at the pathway

11. Neuron Transmission In order to understand how the symptoms of PKD occur, one must understand how DA is transmitted in the brain. Students should then do the 2 activities. Questions about this… –Should the answers to the questions show up as multiple choice? –Should the answers be recorded in the lab notes once answered correctly? –Should there be information in the EMR to assist with the answers?

12. Neuron Transmission Activity 1 Watch animation of the neuron synapse and answer the following questions: –How does dopamine transmit a signal from the axon of one neuron to the dendrite of another? –What happens to dopamine molecules once the signal has been transmitted?

13. Neuron Transmission Activity 2 Watch the animation of a group of DA neuron synapses and answer the following questions: –When DA molecules are released, one of two things will happen to them. What are they? –What cells do you see here besides DA neurons? What are their functions?

14. Dopamine Tone and Parkinson’s Disease The density of DA molecules around the neurons is called dopamine tone. The amount of them is also referred to as the dopamine tonic level. The dopamine tone is thought to be responsible for enabling dopamine to perform its functions efficiently. One of the major breakthroughs in the study of Parkinson’s Disease was the discovery of the relationship between DA neuron concentration, DA tone, and PKD symptoms. Students are then instructed to proceed to the 2 activities.

15. Dopamine Tone and Parkinson’s Disease Activity 1 At what percentage of DA neuron loss do PKD symptoms begin to occur? PKD is not diagnosed until symptoms occur. At that point, what the percentage of DA neurons does the victim have left?

16. Dopamine Tone and Parkinson’s Disease Activity 2 At what DA neuron concentration does DA tone begin to decrease? How does this compare to the DA neuron concentration at which PKD symptoms begin to occur? Summarize the relationship between DA neuron concentration, DA tone, and PKD symptoms.

17. Maintenance of Dopamine Tone As can be seen from previous studies, DA tone begins to fall after about an 80% loss of DA neurons. At that same point, PKD symptoms begin to become visible. Scientists were not surprised to find a correlation between these factors. What did surprise them was the large percentage of DA neurons and individual could lose and still seem to function normally. How is DA tone maintained despite the loss of so many DA neurons? The answer to this question is currently unknown; however, two scientists have come forward with hypotheses as to how the maintenance of DA tone is possible in the face of the loss of so many DA neurons.

18. Introduction to Garris’ work Dr. Paul Garris has proposed the passive stabilization model as one possible answer to this mystery. His premise is a simple one – because each DA neuron both releases and uptakes dopamine, the loss of each DA neuron represents not only the loss of dopamine molecules being released but also one less neuron taking up dopamine molecules. Of course, every hypothesis must be supported by research. Enter the neuro lab and see for yourself if Dr. Garris’ hypothesis is supported or refuted.

19. Research in Parkinson’s Disease Students are instructed to go to the ______ room and do the experiment found in the protocol. INSERT LAB HERE Do we want students to create a hypothesis or choose a hypothesis going into the experiment?

20. Looking at the Lab Data The data from the experiment indicate that the as the number of dopamine neurons decreases, so does the uptake and release of dopamine. Is Garris’ passive stabilization hypothesis supported by this data? Explain your answer. How can dopamine tone remain stable as dopamine release decreases?

21. Leaving the lab Student is instructed to then leave the lab and return to the Parkison’s Disease tutorial.

22. The Bucket Theory While Garris’ passive stabilization hypothesis is supported by the data, why dopamine tone suddenly drops after the loss of about 80% of an individual’s dopamine neurons. In order to help explain this phenomenon, Garris created the Bucket Theory. Student is instructed to do activities.

23. The Bucket Theory Activity 1 Examine the Bucket Theory animation below and …(need to determine what students should do here) One thing that the original Bucket Theory didn’t seem to quite explain was why the 20% DA neuron threshold was so important. Dr. Garris hypothesized that there must be something else affecting the DA tone.

24. The Bucket Theory Activity 2 Look at the DA neuron synapse and hypothesize as to what else might be affecting DA tone. Glial cells take up minimal amounts of dopamine and, when there is a sufficient concentration of DA neurons, the glial cells do not seem to affect DA tone. However, at a DA neuron concentration of less than 20%, the uptake of DA by the glial cells seems to have a much greater impact on the DA tone. This line of thought led to a revamping of the Bucket Theory.

25. The Bucket Theory Activity 3 Examine the revised Bucket Theory animation below and…(need to determine what students should do here) Another way to look at the passive stabilization model is through computer modeling. Watch the video below to become familiar with the computer model.

26. The Bucket Theory Activity 4 Explore the computer model of the passive stabilization theory. Need to figure out activity/questions