Parkinson's disease

Question 1

what is Parkinson’s

Answer 1

a neurodegenerative condition resulting in the death of dopamine containing cells in the substantia nigra (in the basal ganglia)

Question 2

what is the pathophysiology of Parkinson’s Disease

Answer 2

a disorder of the basal ganglia and the loss of dopamine neurons in the substantia nigra pars compacta

Question 3

what is dopamine

Answer 3

a natural neurotransmitter found in the brain that plays a major role in communicating across systems

Question 4

what are the 2 main pathways that initiate/ prevent movement in the basal ganglia

Answer 4

• direct pathway
• indirect pathway

Question 5

what is the direct pathway

Answer 5

excitatory pathway
- stimulates movements

Question 6

what is the indirect pathway

Answer 6

inhibitory pathway
- inhibtis movements

Question 7

common motor symptoms of Parkinon’s

Answer 7

• tremors
• rigidity/ lead pipe arm (stiff muscles moving through full range and stiffness remains constant at any speed)
• spacticity - if speed increases then will become more stiff (cogwheel - juddering effect)
• bradykinesia
• postural instability
• walking difficulties e.g. start hesitation, short shuffling steps
• freezing during movements
• loss of expression - face can freeze so stays the same (masked face)
• speech problems

Question 8

what is bradykinesia

Answer 8

slowness of movement ad speed
or
progressive hesitations/ halts as movements are continued

Question 9

what is the usual postural instability

Answer 9

usually hunched which moves centre of mass forward which can cause impaired walking

Question 10

what speech problems do parkinsons patients have

Answer 10

• Softened voice.
• Reduced volume to your voice.
• Speaking in an unchanging pitch (monotone).

Question 11

common non-motor impairment symptoms of Parkinson’s disease

Answer 11

• cognitive decline
• mood changes
• loss of smell
• sleep dysfunction: insomnia, nightmares, sleep walking
• constipation
• anxiety/ depression

Question 12

why does Parkinson’s disease cause symptoms

Answer 12

• nerve cells containing dopamine in the basal ganglia (an area of the brain that controls movement) become impaired and/or die
• dopamine is a neurotrasnmitter so without it, signals sent from the brain down the efferent pathway can be interrupted or not sent altogether.
• the same goes for the afferent pathways

Question 13

describe the diagnosis of parkinson’s

Answer 13

• difficult to detect in early stages
• has various stages of development
• needs functional imaging (SPECT & PET scans)

Question 14

how is Parkinson’s managed medically

Answer 14

• using drugs to relieve symptoms however the pathological process cannot be halted

Question 15

why is levodopa used as a drug for parkinson’s patients

Answer 15

converts into dopamine
- having more dopamine in the body will mean that more signals can be sent up afferent pathway and down efferent pathway to minimis symptoms

Question 16

why are dopamine agonsists used as a drug for Parkinson’s patients

Answer 16

it mimics the effects of dopamine

Question 17

why are COMT inhibitors used as a PD medication

Answer 17

COMT is an enzyme in the body
- when a person takes levodopa, COMT can deactivate levodopa before it enters the brain and CNS, so COMT inhibtors prevent this from happening

Question 18

why are Mao-B inhibtors used as PD medication

Answer 18

MAO-B enzymes naturally break down severla chemicals in the brain, including dopamine, inhibting this process makes mroe dopamine available

Question 19

why is deep brain stimulation used as a medication for PD

Answer 19

• electrodes are inserted into a targeted area of the brain, using MRI and, at times, recording of brain cell activity during the procedure.
• a second procedure is performed to implant an impulse generator battery which is similar to a heart pacemaker and approximately the size of a stopwatch. It is places under the collarbone or in the abdomen and delivers an electrical stimulation to targeted area of the brain that control movement.

Question 20

why is the benefit of physiotherapy to a PD patient

Answer 20

• stretching can improve ROM - postural muscles become stiff which causes hunched posture so can be improved
• falls prevention
• improve mobility
• cueing - audible visual
• aids and adaptions
• onwards referral: long term conditions
• increase indenpendence of patient
• family support
• education

Question 21

Why does death of dopamine containing cells in the brain cause Parkinson’s disease symptoms?

Answer 21

There’s not enough dopamine to regulate the direct and indirect pathways

Question 22

why might parkinson’s patients have a hunched back

Answer 22

no impulses to stand up straight sent down efferent pathway form basal ganglia due to lack of dopamine neaurons

Question 23

why do Parkinons patients have a masked face

Answer 23

a lack of dopamine in the brain can stop your facial muscles working as impulses arent carried through to the muscles