Parkinson's Disease Flashcards
(96 cards)
1
Q
What is PD
A
UMN Progressive disease
2
Q
Define Parkinsonism
A
Clinical syndrome characterized by a variable combo of motor signs
- Tremor
- Bradykinesia
- Rigidity
- Decreased postural control
- Gait difficulties
3
Q
Define syndrome
A
A group of symptoms that occur together
4
Q
Define Idiopathic Parkinson’s Disease
A
Chronic, progressive neurodegenerative condition characterized by degenration of dopaminergic neurons, leading to both motor and non-motor impairments
5
Q
What is the 2nd most common neurodegenerative disorder
A
Idiopathic Parkinson’s Disease
6
Q
By 2040, how many people will have PD (estimate)
A
13 million people
7
Q
How many people each year are diagnosed with PD in the US
A
60,000
8
Q
What percent of US pop over 65 has PD
A
1.6%
9
Q
T or F: More females have PD
A
F - more men
10
Q
What decade of life does a diagnosis usually occur?
A
5th and 6th decade of life
11
Q
What percent of people show symptoms < 45 yo
A
5-10% of people
12
Q
What does dopamine depletion in PD lead to
A
Abnormal habitual learning and loss of motor control
13
Q
What is loss of automaticity
A
Inability to perform movements without attention directed towards the movement
14
Q
What occurs with loss of automaticity
A
Habitual behaviour decrease/problems
Flexibility of motor behaviour is reduced
Dual tasking decreased
Exaggerated dependence on external motor drive
15
Q
What does loss of automaticity contribute to
A
Micrographia Decreased: - arm swing - stride length - facial expression
16
Q
What gets damaged in PD
A
Sensorimotor striatum of the BG - SNc
17
Q
What is the etiology of PD?
A
- Unknown but combo of: genetic toxic infectious other/unkown
18
Q
How is a diagnosis Made
A
ABSENSE of a specific marker or diagnostic test (It’s a diagnosis of exclusion)
19
Q
What is a DaTSCAN
A
- Specialized imaging technique captures detailed pictures of the dopamine neurons that is able to determine whether there is a REDUCTION OF DOPAMINE CELLS, which usually occurs w/PD
20
Q
How is a clinical Dx made
A
Med Hx, presentation of symptoms (unilat onset, resting termor, levodopa response, LT comp. of levadopa treatment), exam findings, response to meds, and disease course
21
Q
What is a method used to classify the degree of pathology in PD?
A
Braak Stages of PD
22
Q
Presentation of Braak Stages 1 & 2
A
Impaired olfaction and constipation, possible presence of lewy bodies
23
Q
When in the Braak stages are ___ displayed?
a) Sleep
b) Motor
c) Emotional
d) Cognitive
A
a) Mid-stage (3&4)
b) Mid-stage (3&4)
c) Later braak stages (5&6)
d) Later braak stages (5&6)
24
Q
What occurs in the brain in Braak 3&4
A
Lewy bodies move to midbrain and frontal cortex
25
What occurs in the brain in Braak 5&6
Lewy bodies move to frontal cortex and sensorimotor cortex
26
What is a method used to measure the degree of disease in PD?
Modified Hoehn and Yahr Staging
27
What is Stage 0 of Modified Hoehn and Yahr Staging
No signs of disease
28
What is Stage 1 of Modified Hoehn and Yahr Staging
Unilateral disease
29
What is Stage 1.5 of Modified Hoehn and Yahr Staging
Unilat + axial
30
What is Stage 2 of Modified Hoehn and Yahr Staging
Bil disease w/o impairment of balance
31
What is Stage 2.5 of Modified Hoehn and Yahr Staging
Mild bil disease with recovery on pull test
32
What is Stage 3 of Modified Hoehn and Yahr Staging
Mild to moderate bil disease; some postural instability; physically independent
33
What is Stage 4 of Modified Hoehn and Yahr Staging
Severe disability; still able to walk or stand unassisted
34
What is Stage 5 of Modified Hoehn and Yahr Staging
WC bound or bedridden unless aided
35
What are some premanifest symptoms of PD
```
Hyposmia (decreased olfaction)
Constipation
Depression & Anxiety
REM sleep behaviour disorder
Dec. Arm swing
Mild motor fun. changes
```
36
What are some early symptoms of PD
```
Unilat tremor
Rigidity
Mild gait hypokinesia
Micrographia
Reduced speech volume
```
37
What are some middle symptoms of PD
Bil bradykinesia, axial and limb rigidty
Bal and gait dficits/falls
Speech impairments
May need ass toward end
38
What are some late symptoms of PD
Severe voluntary mvmt impairments
Pulm fun & swallowing
Dependence in mobility, self-care, and ADLs
39
What are the clinical features of PD
Tremor
Rigidity
Bradykinesia
Loss of postural control
40
What is the first sign in 70% of people w/PD
Tremor
41
T or F: Tremor is a fast frequency
False, it is slow, low (4-6 Hz)
42
List and define the two types of rigidity
Cogwheel: Jerky resistance to passive mvmt
Leadpipe: Sustained resistance to passive movement
43
What mm group is more affected w/Rigidity
Flexors --> stooped posture
| Proximal earlier
44
What is rigidity characterized by
Characterized by increased resistance to passive movement that affects proximal mm early
45
What is the most disabling of the early PD symptoms?
Bradykinesia
46
Define bradykinesia
Slowness of voluntary mvmt
47
Define Hypokinesia
Reduction in mvmt amplitude - primary cause of dec gait speed and step length
48
Define akinesia
Freezing episodes
49
T or F: Individuals w/PD have perfect kinesthetic perception
False - it is impaired
50
What is true of postural control
It worsens with disease progression and:
- Dec. limits of stability, mag. of postural responses
- Impaired postural adaptations
- Altered anticipatory postural adjustments
51
What % of PD Pts have fallen in the previous year
70% of PD Pts
52
What are some secondary motor symptoms
Motor performance
Gait
Dual Tasking
53
What gait disturbances are present w/PD
Slower, shorter step lengths w/Inc. variability and dec. trunk rot.
54
What is true of dual tasking in PD
It will lead to dec. gait speed and inc. gait variability and manifests as difficulties prioritizing attention in complex environments
55
What is hypokinetic dysarthria
Reduced speech volume, monotone speech, mumbled and imprecise articulation, variable speaking rates
56
What is Hypomimia
Reduced facial mvmts/expression, slowed eye mvmts/blinking,
57
What is micrographia a form of
Hypokinesia
58
List some nonmotor symptom categories of PD
Autonomic dysfunction
Cognitive and emotional dysfunction
Sensory
Sleep disorders
59
What is important about nonmotor symptoms
THEY ARE TREATABLE
60
What is postprandial hypotension
BP drops after meals
61
What are some Autonomic Dysfunctions that can occur w/PD
```
CV Dysfunction
Thermoregulatory Dysfunction (hyperhydrosis)
Fatigue
Respiratory Dysfunction
```
62
What are some examples of CV Dysfunction
Orthostatic hypotension and post prandial hypotension
63
What are some respiratory dysfunctions w/PD
Difficulty with getting air out
64
What are some Cog/Emo/Behav. Changes
Apathy and OC Behaviour
65
What sensory changes w/PD
Olfactory - 70-90% Pts
| Visual - "tired eyes"
66
What can be a treatment of OH
Immediately: Drink 12-16 oz of ice water
Chronic: Inc. fluid and salt, elevate head of bed, abd binder, pressure stockings
67
What is a good treatment for fatigue in PD
EXERCISE !!!
68
What is a good treatment of Respiratory Dysfunction
Inspiratory and expiratory mm strength training
69
What percept of PD Pts develop:
Major depression
Anxiety
30-45 dep
| 25-49 anx.
70
What are the goals of medicine
1) Provide symptomatic relief for motor and non symptoms
2) Min. motor fluctuations and max "ON" Periods
3) Increase amount of dopamine available in BG
71
List the medications for motor symptoms
- L-Dopa
- Dopamine agonist
- COMT Inhibitors
- MAO-B Inhibitors
- Antiviral
- Anticholinergics
72
When was L-dopa first introduced
Late 60s
73
What is the most effective treatment of motor symptoms of PD
Carbidopa + Levodopa to prevent L-DOPA being converted into dopamine in the bloodstream and reduce risk of side effects
74
When should L-dopa be taken for max absorption
1/2 hour prior to mean and 1 hr after a meal
75
What is a myth about L-dopa and what is the truth regarding it
Over time L-dopa stops working - False, overt the therapeutic window narrows as the efficacy threshold rises, and the dyskinesia threshold lowers
76
What are the L-dopa risk factors for motor compications
Younger age at onsent of PD
Disease severity
Higher daily L-dopa dosage
Longer disease duration
77
What is a dopamine agonist
A drug that mimics dopamine by stimulating postsynaptic dopamine receptors directly that works to treat the 4 primary clinical PD symptoms
78
What is COMT
An enzyme involved in the peripheral degradation of L-dopa/dopamine
79
What is a COMT inhibitor
Blocks the COMT enzyme to increase the availability of dopamine and effectively allow more time for L-dopa to be absorbed in the brain
80
What is MAO
An enzyme in the cells of the body that breaks down neurotransmitters, w/B being mainly in the brain
81
What is a MAO-B inhibitor
A drug that blocks the action of MAO-B to provide the brain more time to absorb and potentially boost the effectiveness of levadopa
82
What antiviral drugs are used for PD and why
Amantadine to increase release of DA and then blocks ACh receptors -> can decrease dyskinesia
83
What is the role of Anticholinergics in the treatment of PD?
To treat tremors by blocking ACh receptors to inhibit dopamine reuptake
84
List the 2 types of Sx Procedures that can be done for PD
Lesioning procedures
| DBS
85
What are some types of lesioning
Both rarely performed today
Pallidotomy (GP destroyed)
Subthalamotomy (subthalamic nuc. destroyed)
86
What is done in DBS
Electrode into brain and attaching it to computerized pulse generator which is implanted under the skin in the chest
87
What are the 3 DBS targets for PD
STN (Subthalamic nucleus)
GPi (Globus Pallidus Interna)
Thalamus
88
T or F: DBS increases the amount of dopamine in the brain
FALSE!! It paces the nuclei (STN and GPi) w/a constant steady-frequency to compensate for the excessive and abnormally patterned electrical dc in the GPI or STN
89
1) DBS candidate
| 2) DBS non-candidate
1) Pt w/PD that is dopamine responsive, age 20-75
2) Non PD Parkinson symptoms, severe cognitive/depressive symptoms, inability to have sx, poor compliance or poor social support systems
90
Which are some benefits of DBS
dec.: dyskinesia, dystonia, tremor, brady/hypokinesia, stiffness
Improve sleep
91
What are some risks of DBS
2-3% risk of stroke, dec. in verbal fluency, changes in modd/apathy
92
Define capacity
What you measure in the clinic
93
Define performance
Measured in real life
94
What is true about people w/PD and exercise?
Although Pts know the importance of exercise, they are not meeting the recommendations
95
T or F: Once Pts reach moderate PD, it is too late for them to start exercising
FALSE!!! Exercise will make improvements in dopamine loss at any point in the disease
96
What are the key elements of PT Intervention?
- Early referral
- Promote an active lifestyle
- Rx of exercise [aerobic, strength, flexibility, and balance]
- task specific training
