Parkinson's Disease

Question 1

As it related to motor control specifically, the basal ganglia utilize indirect and direct pathways to ____ and ____movement. They also prevent unwanted movement via _____.

Answer 1

initiate and execute
inhibition

Question 2

4 additional role of the BG (not including motor control) are

Answer 2

eye-movement loop (spatial attn/saccades)
goal-directed behavior
social behavior loop
emotion loop

Question 3

Primary NTs of the BG system are:

Answer 3

dopamine (movement facilitator)
Ach
GABA/Glutamate

Question 4

T/F: The primary neurotransmitter for the direct/indirect motor pathways is dopamine.

Answer 4

false. they are glutamate/ GABA

Question 5

Describe general demographics related to PD incidence. and prevalence.

Answer 5

most onsets >/= 60y/o
men>women
decreased prevalence in Black/Asian pop

Question 6

Etiology unknown, PD is considered to be an interaction of these factors (3)

Answer 6

age, genetics, and environment

Question 7

Pathophysiology of PD involves the depletion of ___in the BG and loss of ____ in the substantia nigra.

Answer 7

dopaminergic neurons
DA stores

Question 8

PD is definitively diagnosed via ____ but can also be suggested via SPECT scan/ DaTscan, levodopa/carbiopa trials, and ___

Answer 8

post mortem examination; clinical exam (via exclusion)

Question 9

Cardinal motor s/s of PD include: brady/hypo/akinesia, rigidity, tremor, and ____ (3)

Answer 9

postural instability, weakness, and breakdown of complex motor planning

Question 10

Addressing postural instability should always be a priority for our PD pts as its a huge RF for falls along with ____ (2)

Answer 10

disease severity
gait impairments (esp freezing)

Question 11

T/f: Weakness in PD only comes from delayed MU recruitment.

Answer 11

false. it’s multifaceted and can also be due to decrease torque production , asyncronization. disuse and fatigue.

Question 12

What is the difference between continuous and episodic gait changes we may observe in PD?

Answer 12

continuous: overall hypokinesis, poor variability and posture, asymmetry

episodic: freezing, festinating, midline disorientation, en bloc turns

Question 13

____/____is often an early symptom expressed by a majority (60-80%) of PD pts. It’s attributed to abnormal ___related to dopamine levels.

Answer 13

pain/paresthesia; modulation

Question 14

Common areas of hyperparesthesia and pain are:

Answer 14

low back, legs, shoulders and face

Question 15

between postural instability phenotype and tremor-dominant phenotype, which is more prevalent? Which has the lowest morbidity (motor, non-motor and cog) ?

Answer 15

most prevalent/lowest mobility: tremor-dom

Question 16

These 3 drug classes are typically used in conjunction with levodopa/carbidopa, the first line defense.

Answer 16

dopamine agonists, COMT inhibitors and anticholinergics

Question 17

T/F: COMT inhibitors are typically used to manage tremors in early stage PD.

Answer 17

false: it’s anticholinergics.

Question 18

Levodopa/DBS does NOT help with:

Answer 18

improving axial rigidity
external perturbation rxn strategies
later stage hypokinetic gait
“on” state freezing

Question 19

Why might someone choose to try deep brain stimulation (DBS)?

Answer 19

motor s/s no longer responding to meds;
increased on periods and reduced frequency of off times

Question 20

With the exception of _____, life expectancy for PD pts is often slightly less than avg.

Answer 20

PD dementia (Lewy Body Dementia)

Question 21

The 2 most prevalent fatal sequelae are

Answer 21

CHF
pneumonia

Question 22

Negative prognostic indicators of PD include smoking, symmetry of s/s, young onset, and (4)

Answer 22

male gender
phenotype (postural instability worse)
Poor/early decline in cog
higher UPDRS

Question 23

The PDQ-39 assess QOL over the last ____ in the domains of mobility, ADLs, bodily discomfort, cog, and ____

Answer 23

month; emotional wellbeing, stigma, social support and communication

Question 24

The MDS-UPDRS assessesburden and extent of PD for what duration?

Answer 24

the entire course of the disease

Question 25

OF all 4 parts of the MDS-UPDRS, which are the most relevant for us in the clinic?

Answer 25

Pt 1: non-motor experience of daily living
Pt 3: motor examination

Question 26

MoCA cutoff score

Answer 26

26 points

Question 27

T/F: The Parkinson’s fatigue scale excludes cog/emotional fatigue as well as severity and frequency of symptoms.

Answer 27

True. it just measures presence of physical impact on fn.

Question 28

The freezing of gait questionnaire assess FOG (related/unrelated) to falls. Most of the questions relate to frequency.

Answer 28

unrelated

Question 29

take a pause and look through the modified Hoehn and Yahr Scale.

Question 30

Early stage (H&Y 1-2.5) treatment of PD. should emphasize

Answer 30

active and normal lifestyle
initiation + monitoring exercise program (think Amp and symmetry)
dual and complex motor tasks

Question 31

Middle stage (H&Y 3-4) treatment of PD. should emphasize

Answer 31

-early stage w/ mod to max participation esp during “ON” times
-strategy training/cueing w/ increased cog input
-fall prevention/education

Question 32

late stage (H&Y 5) treatment of PD. should emphasize

Answer 32

-caregiver ed (cueing, ROM)
-sitting posture/tolerance
-sequelae management

Question 33

among others, the 2 most common triggers of freezing are

Answer 33

start hesitation and turn hesitation

Question 34

The 4 S’s when freezing are internal strategies during which a person should:

Answer 34

stop
stand tall
shift weight
step BIG

Question 35

Turn strategies should encourage:

Answer 35

COG over BOS
wider turns (big space)
exaggerated march (small space)
clock turns

Question 36

____is a postural abnormality that can observed when a PD pt is lying supine.

Answer 36

shadow pillow