parkisons

Question 1

what are the classifications of PD

Answer 1

primary/idiopathic

secondary

heredogenerative

multiple-system degeneration or parkinsonism-plus

Question 2

give examples of primary/idiopathic PD

Answer 2

parkinson’s disease

juvenile parkinsonism

Question 3

give examples of secondary PD

Answer 3

infections, drugs, toxins, vascular or trauma

toxoplasmosis
- from feces of cats c parasites; common in HIV pts that causes lesion on BG

Question 4

give examples of heredogenerative PD

Answer 4

huntington’s or wilson disease

Question 5

give examples of multiple-system degeneration or parkinsonism-plus

Answer 5

progressive supranuclear palsy

corticobasal degeneration

lew body dementia

multisystem atrophy

Question 6

discuss progressive supranuclear palsy

Answer 6

PSP
- rigidity
- diff c vertical gaze
- has ssx of PD

Question 7

discuss lewy body dementia

Answer 7

LBD
- combi of parkinsons and dementia
- no cure; often presesnt c depression

Question 8

discuss multisystem atrophy

Answer 8

striatonigral degeneration - affects striatum and SN

olivopontocerebellar atrophy - OCPA
- bradykinesia
- balance probs
- sporadic or sponty in occurence

shy drager syndrome
- ssx of PD but has autonomic probs; BP or cant sweat

Question 9

discuss prevalence of PD

Answer 9

20-30 per 100k and more common in males (3:2)

rising prevalence with age

Question 10

discuss the pathogenesis of PD

Answer 10

neurodegenerative disease c depigmentation of the substantia nigra = loss of dopaminergic input in BG = extrapyramidal sx

from imbalance bet dopamine (inhib) and ACH (excitatory); normal ACH but onti dopamine kaya hyperkinetic - resting tremors

PD is both hypokinetic and hyperkinetic

Question 11

discuss the etiology of PD

Answer 11

unknown tlaga but

influence of aging - since neurons also degenerate

environmental toxins - aluminum cans

genetics pero saks lng

oxidative stress - seen in DM AND HTN

X-LINKED DYSTONIA - PD

Question 12

exp oxidative stress theory

Answer 12

alterations of SN in PD is suggestive of oxidative damage

• inc iron, aluminum
• lack of isoferritins
• reduced glutathione
• selective defect in complex 1 of mitochondrial respiratory chain
• damage to lipids, DNA and proteins
• DM and HTN that leads to dementia

Question 13

in essence what are the possible causes of PD

Answer 13

oxidative stress

mitochondrial dysfunction

abnormal protein clearance

excitotoxicity

protein handling dysfucntion

Question 14

age for young onset PD

Answer 14

onset < 40 yo

Question 15

age for juvenile onset PD

Answer 15

onset < 20 yo

Question 16

what is parkin mutation

Answer 16

major cause of young onset autosomal recessive PD and isolated juvenile PD

Question 17

this is usually seen in autosomal dominant PD

Answer 17

mutations in the 𝝰 synuclein and ubiquitin carboxyl hydrolase:

Question 18

most PD symptoms do not appear til striata DA levels decline by ______

Answer 18

at least 70-80%

Question 19

symptoms of PD

Answer 19

TRAP

• tremors: resting
• rigidity: cogwheel
• akinesia or brady: rebound or slow initiation and execution
• postural instab: imbalance, stoop posture; pwede din gait; shuffling gait c lack of heel strike; righting reflex

Question 20

further discuss resting tremors

Answer 20

4-6 Hz

will begin in the hand unilaterally and usually at early stage

disappears c voluntary movement but in advanced di na nawawala

disappears with sleep; more present in > 80 yo and if stressed

pill rolling - unconscious movement of index and thumb

basta dapat ma differentiate with essential (8 Hz) and physiological (12Hz) which are more of cerebellar problem

Question 21

further discuss limb rigidity

Answer 21

inc tone and resistance to movement of both UE and LE

should be cogwheel and differentiated from spastic

ratchet like resistance dapat not matigas then mag give in which is spastic

Question 22

further discuss akinesia or bradykinesia

Answer 22

dec speed & amplitude of complex voluntary movement

slowness in initiating and sustaining movement

how to elicit:
- micrographia: lumiliit sulat
- tapping fingers
- twiddling of hands
- pinching and circling
- tapping c heel

usually one side is slower in early stages; misdiagnosed as stroke

akinesia is for late stage

Question 23

further discuss postural instab

Answer 23

how to elicit
- ask pt to stand parang romberg tas usually wide based
- pt will fall is positive test
- off balanced when turning
- parkinsonian gait
- stoop posture

Question 24

discuss diagnosis for PD from ward and gibb

Answer 24

presence of at least 2/4 cardinal signs; but 2/3 lng at their time since wala pa postural instab

presence of 2 of the ff
- marked response to levodopa
- assym of signs; unilateral
- assymetry at onset

evidence of disease progression

absence of clinical features of alternative dx

absence of etiology known to cause similar features; secondary PD

Question 25

stage 0 PD

Answer 25

no clinical signs or evidence

Question 26

stage 1 PD

Answer 26

Unilateral involvement

major features of tremor, rigidity or bradykinesia

minimal functional impairment

Question 27

stage 2 PD

Answer 27

bilateral involvement but no postural abnormalities

Question 28

stage 3 PD

Answer 28

mild to mod bilateral disease; mild postural imbalance

but can still function indep

Question 29

stage 4 PD

Answer 29

bilateral involvement c postural instab and requires assistance

Question 30

stage 5 PD

Answer 30

severe; pt is restricted to bed or w/c unless aided