Lecture 1 - Pathology - mechanisms + management of PD/MS/MND

Question 1

What is the age of onset for PD/MND/MS?

Answer 1

MS - likely to be dx’d earlier - 20s or 30s (even in teens)

PD+MND - both are typically 60s and incidence goes up with age; pt’s will be living with these diseases for longer given higher life expectancy in developed countries

Question 2

What is pathophysiology for PD/MND/MS

Answer 2

PD - basal ganglia; might also have gut involvement - then ascends into brainstem?

MND - UMNL + LMNLs and NO sensory impairments; small % can have cognitive impairment; weakness though will be the primary component

MS - autoimmune - affects the myelin sheath; s/sx depends on location of lesion

Question 3

Prognosis

Answer 3

MND - worst prognosis - 6mons to 5 years

PD - prognosis is normal as possible but of course this is on a spectrum

MS - depends on type of MS

Question 4

Motor Impairments of PD/MND/MS

Answer 4

PD:

• bradykinesia
• hypokinesia
• resiting tremor
• rigidity
• balance and walking affected
• freezing

MND:

• mainly weakness
• can also see spasticity if UMNL

MS:

• demyelination can occur anywhere so symptoms will vary
• weakness, incoordination, spasticity, sensory abnormalities, cerebellar ataxia

Question 5

Sensory Impairments of PD/MS/MND

Answer 5

• MND - no sensory involvement
• MS - sensory (optic nerve, paresthesia, loss of proprioception, vibration sense, tactile sense)
  PD - 2x the amount of pain that general pop does - this can be 2º or 1º

Question 6

Cognitive/emotional Impairments

Answer 6

MND - 20% with UMNL get dementia; cog/emot least common
MS - 50% develop cognitive/emotional impairments
PD - 80% get dementia within 20 yrs; 25% have subtle cognitive changes on diagnosis; depression, anxiety, cognitive impairments increase with disease progression

Question 7

Medical Management of PD/MS/MND

Answer 7

PD - L-dopa effective for first 3-5 years; make sure you know whether the pt is on the drug or not when administering tests as it will affect their performance

MND - meds might only slow down progression by months

Question 8

Type of MS (know how to draw a graph of each showing progression)

Answer 8

1. Relapsing remitting (gets worse, gets better; in-between periods there’s NO progression)
2. Secondary progressive (begins like RRMS, then progresses at a variable rate)
3. Primary progressive (this is the worst! it progresses from the get go; some variants can have brief plateaus or minor improvements but generally gets worse quickly)
4. Progressive relapsing (shows progression from the onset but with clear relapses and remissions; these acute episodes can be full or partial recovery)