Flashcards in 17 - PD clinical Deck (21):
4 clinical features of PD
tremor, bradykinesia, rigidity, postural instability/gait disorder
diagnosis favored by? (5)
unilateral onset, asymmetry, rest tremor, levodopa response, dsykinesias
atypical features (6)
early dementia, hypotension, supranuclear palsy, cerebellar signs, pyramidal signs, gait and balance
pathophysiology of PD: 3?
neurochemical changes, striatal changes, cortical dysfunction
4 neurochemical changes
DA, NA, 5HT, ACh
cholinergic loss in AD vs. PD
PD: has more cholinergic loss
8 early non motor symptoms
smell loss. REM sleep behaviour disorder, restless leg syndrome, fatigue, depression, anxiety, apathy, consitpation
tremor: what type? hz?
5 - 9 Hz rest tremor
rigidity: type? distict from?
cogwheel rigidity: rate independent stiffness with superimposed tremor. distinct from spasticity: rate dependent stiffness
relationship b/w neuron density and UPDRS score?
linear relationship: decreased density of neurons = higher/worse score
selective loss in PD?
more in the ventral part of nigra
DA transporter imaging?
PD: see less, also asymmetric. if you had essential termor you wouldn't see change from control
late PD: complications?
within 3 years up to 50% develop wearing off or on/off, dyskinesias, freezing. also neuropsych and autonomic complications
motor complications young vs. old
young have worse fluctuations and dyskinesias : more plasticity?
treatment of wearing off: if on DA agonist? if on levadopa or decarboxylase inhibitor?
DA agonist: increase amount. L/DI: increase dose frequency or switch to controlled release.
treatment of dyskinesias: ex? effective for who?
preventive with DA agonists. surgery, amantadine. effective in younger, no difference in older once dysk has developed
agonists and dyskinesia risk?
agonists reduce risk: not as good benefit, but less likely to get dyskinesia
postural and gait impairment: severity? prognosis? medication? may suggest?
rarely severe early in course of disease. worse prognosis. not as responsive to medications. involvement of other distinct nuclei or wide spread disease, alternate diagnosis.
dementia in PD?
prevalence 10 - 40%, shortens survival
risk factors for PD (4)
older age, low education, decrease memory + verbal fluency, axial motor impairment