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parkinson's disease Flashcards

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1
Q

what is PD

A
  • the most common serious movement disorder
  • a degenerative condition of the basal ganglia
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2
Q

pathophysiology of PD

A
  • synucleiopathy
  • degeneration of dopaminergic neurons in substantia nigra of midbrain
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3
Q

synucleiopathy

A

neurodegenerative diseases characterised by the abnormal accumulation of aggregates of alpha-synuclein protein

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4
Q

?% of neurons die before the disease is clinically apparent

A

70-80%

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5
Q

is PD’s onset gradual or rapid

A

gradual

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6
Q

is PD’s progression gradual or rapid

A

gradual

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7
Q

is PD symmetrical or asymmetrical

A

asymmetrical

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8
Q

most common initial feature of PD

A

resting tremor in one hand (pill rolling)

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9
Q

prevalence of PD

A
  • increases with age
  • 40 in 100,000 (40-49 y/o)
  • 1900 in 100,000 (> 80 y/o)
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10
Q

rising PD prevalence with ?

A

age and men

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11
Q

rising PD incidence with ?

A

men

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12
Q

? people with PD in ROI

A

estimated 12,000 (no published prevalence studies)

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13
Q

PD is set to ? in 20 years

A

double

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14
Q

PD prognosis

A
  • reduces life expectancy
  • 24-40% develop dementia
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15
Q

untreated PD patients prognosis (historically)

A
  • severely disabling degree of immobility
  • risk of bronchopneumonia, septicemia, or pulmonary embolus after 7-10 years
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16
Q

?% of PD patients with develop dementia

A

25-40%

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17
Q

why does dementia develop in PD

A

spread of degeneration and Lewy bodies to the cerebral cortex and limbic structures

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18
Q

factors that influence the risk of dementia in PD

A
  • age of onset
  • disease duration/severity
  • APOE genotype
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19
Q

what is largely responsible for reduced life expectancy in PD

A

dementia

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20
Q

treatments are ?

A

symptomatic but improve life expectancy

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21
Q

causes of secondary parkinsonism

A
  • drug induced
  • post encephalitis
  • post head injury
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22
Q

types of atypical parkinsonian syndromes

A
  • progressive supranuclear palsy (PSP)
  • multiple systems atrophy (MSA)
  • corticobasal syndrome (CBS)
  • dementia with lewy bodies (DLB)
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23
Q

IPD is ?% of all parkinonism

A

≥80%

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24
Q

types of parkinsonisms

A
  • ideopathic parkinson’s disease (IPD)
  • secondary parkinsonism
  • atypical parkinsonian syndromes
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25
in IPD, what is consistent with increased prevalence
age after 50 (steady) and 60 (steep)
26
cause of IPD (genes, etc.)
- unknown - environmental and genetic factors implicated
27
family history in ?% of IPD
20-30%
28
IPD onset before 30 suggests ?
hereditary form on parkinsonism
29
cardinal features of IPD
TRAP - tremor - rigidity - akinesia/bradykinesia - postural instability
30
tremor in IPD
- usually at rest - pill rolling common - disappears with action and during sleep
31
rigidity in IPD
- increased muscle tone - increased resistance to movement
32
akinesia/bradykinesia in IPD
slowness in initiation and execution of movements
33
postural instability in IPD
causes falls
34
motor symptoms of PD
- tremor, bradykinesia, rigidity, postural instability - dysarthria, dysphagia, sialorrhea - decreased arm swing, shuffling gait, festination - micrographia, curring food, feeding, hygiene, slow ADL
35
non-motor symptoms of PD
- cognitive impairment, WFD - depression, apathy, fatigue - sensory symptoms (anosmia, pain, paresthesias) - dysautonomia (orthostatic hypotension, constipation, urinary and sexual dysfunction, abnormal sweating), weight loss - sleep disorders (REM behaviors, vivid dreams, daytime drowsiness, restless leg syndrome)
36
how to diagnose PD
- clinical diagnosis - no definitive test
37
who diagnoses PD
neurologists
38
timeframe to diagnose PD (and why)
- 5+ years - to distinguish from other parkinsonisms
39
types of diagnostic criterias for PD
- UK Brain Bank Criteria - MDS Clinical Diagnostic Criteria for Parkinson's Disease
40
what to consider when diagnosing PD
- hallmark clinical features (TRAP) - neuroimaging to exclude other conditions - response to treatment
41
why is correct diagnosis important
prognostic and therapeutic reasons
42
?% of patients are incorrectly diagnosed
25%
43
common reasons for misdiagnosis of PD
presence of essential tremor, vascular parkinsonism, and atypical parkinsonian syndromes
44
when should PD diagnosis be reviewed
- regularly - if atypical features develop
45
single photon emission computed tomography (SPECT)
- medical imaging technique - find issues with blood flow in the brain - diagnose or check on vascular brain disorders
46
UK Brain Bank Criteria
Step 1 - bradykinesia - rigidity, resting tremor, or posural instability Step 2 - exclude other causes of parkinsonism Step 3 - (at least 3) unilateral onset, resting tremor, progressive, persistent asymmetry, good response to levodopa, levodopa-induced dyskinesia
47
differential PD diagnosis includes
- essential tremor - atypical parkinsonian syndromes - alzheimer's disease - cerebro-vascular disease
48
PD assessment/rating scales
- Unified Parkinson's Disease Rating Scale - Hoehn and Yahr Scale - Modified Hoehn and Yahr Scale
49
Unified Parkinson's Disease Rating Scale
- more holistic assessment - mentation, behavior, and mood (intellectual impairment, thought disorder, depression, motivation) - ADL (speech, salivation, swallowing)
50
Hoehn and Yahr Scale
- impairment-based assessment - scale from 1-5 - 1: unilateral involvement only - 5: wheelchair bound or bedridden unless aided
51
PD treatment
- no cure - symptomatic
52
PD treatment is aimed at ?
restoring neurochemical balance
53
PD treatment is best delayed until when and why)
- until symptoms (functional, occupational, or social) warrant it - due to drug side effects
54
3 most common PD medications
- levodopa - dopamine agonist - enzyme inhibitors
55
levodopa
- gold standard - replaces dopamine - chemical building block that the body converts into dopamine - cross blood brain barrier to reach site of action after oral administration
56
dopamine agonist
acts like dopamine to stimulate nerve cells
57
enzyme inhibitors
prevents breakdown of dopamine
58
less common PD medications
- anticholinergics and amantadine - apomorphine - glutamate antagonist - COMT inhibits - MAO-B inhibitors
59
anticholinergic and amantadine
used for treatment of tremor
60
apomorphone
a strong subcutaneous/infusion dopamine agonist
61
which PD medication can lead to impulsive/compulsive behavior (e.g. gambling)
- dopamine agonists - levodopa
62
levodopa efficacy limited by
complications of motor fluctuations and dyskinesias after 2-5 years
63
levodopa motor fluctuations
- wearing off (doses produce short-lived effects and return of symptoms before next dose) - unpredictable switch from medication benefit (on) and an akinetic-rigid state (off)
64
dyskinesias
involuntary movements associated with drug treatment
65
2 drug-related dyskinesias and symptoms
- peak dose dyskinesia (high dopamine; twisting, turning movements) - wearing off dystonia (low dopamine; painful, sustained muscle contractions)
66
where do wearing off dystonias usually occur
in the feet
67
how many times is levodopa usually taken in a day
3 around meal times
68
how does levodopa progress with the disease (and why)
- higher, more frequent levodopa doses are needed - due to decreasing short and long duration responses to medication and an inability to store excess dopamine - therapeutic window of meds without dyskinesias narrow
69
primary surgical intervention
deep brain stimulation (DBS)
70
surgical intervention for PD
- will not stop disease progression - may control movement symptoms - strict candidacy criteria
71
how does deep brain stimulation (DBS) effect speech
- benefit on voice and speech quality is controversial - varies between studies - can worsen slurred speech, social interaction, and dysarthria subsystems
72
MDT members
- neurology/GP - CNS - SLT - OT - PT - dietician - SW - neuropsychologist - pharmacist
73
SLT managment in PD
- communication (speech, voice, language) - FEDS - specialist AAC - capacity assessment - assessment for DBS - education, support, and counselling - drooling
74
typical dysarthria in PD
hypokinetic dysarthria
75
hypokinetic dysarthria
- low volume - imprecise articulation - dysphonia - monotone - monopitch - abnormal rate - palilalia
76
speech assessments for PD
- AIDS - frenchay dysarthria Ax - UPDRS - dysarthria impact profile - record a speech sample
77
speech treatment for PD
- pacing boards - rate control drills - increased respiratory support - increased vocal fold adduction - increasing stress - focus on speech subsystems - LSVT
78
LSVT
- Lee Silverman Voice Treatment - focused on 1 speech subsystem (minimum cognitive load) - high effort intensive treatment - high level evidence - long term carryover - treat phonation first - impact on rate, articulation, resonance
79
direct effects of LSVT
- deep breath - open mouth - improved articulation - reduce rate
80
indirect effects of LSVT
- improved vocal cord adduction - improved facial expression - reduced vocal instability (e.g. tremor) - improved swallow
81
dysphagia PD may involve which phases of swallowing
oral, pharyngeal, or esophageal phases
82
dysphagia may be present in ? stage of the disease
every stage
83
dysphagia in PD is associated with ?
increased risk of aspiration pneumonia and mortality
84
what is the main cause of death in IPD
pneumonia
85
in PD what factors independently contribute to dysphagia
- age - disease duration - dementia
86
clinical evaluation components
- case history - presentation - OMA - swallow trials
87
PD case history
- time since diagnosis - rate of progression - comorbid symptoms/conditions

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