PARKINSONS Flashcards
(18 cards)
Pathophysiology of IPD
loss of dopanergic cells in substantia nigra –> loss of dopamine in
BG (mvmt, postural control)
frontal lobe (mental processing, motor planning, personality)
ANS (temp regulation, BP, constipation)
overt ss not seen until _% of dopanergic cells have been lost
60-80%
What are prodomal ss of PD
loss of smell
OTHN
sleep disorders
chronic constipation
decades before Dx
genetic testing for PD
through CSF
TRAP is classic clinical features of PD
Tremor, resting
Rigidity, cogwheel
Akinesia, bradykinesia
Postural Instability
What are other motor symptoms of PD
micrographia
speech difficulties (decreased volume)
issues with bed mobility
decreased facial expression, staring
swallowing difficulties
LBP
poor posture
FREEZING or FOG
slight foot drag on one or both sides
functional consequences of motor symptoms of PD
- bed mobility
- sit to stand
- slow and unstable walking
- limited grooming skills
- difficulty conversing with others
What are non motor symptoms of parkinsons
- loss of smell
- temperature dysregulation
- excess sweating
- oily skin and more dandruff
- OTHN
- sleep disturbances
- ANXIETY/DEPRESSION
- less executive function, dementia, less memory for recent events
primary mental symptoms of PD
- normal cognition but decreased executive function (takes longer to respond)
- dementia small percentage (Lewy body Parkinsons)
- psychosis: delusions, hallucinations
Modified Hoehn and Yahr Staging
Stage 0 = No signs of disease
Stage 1 = Unilateral disease
Stage 1.5 = Unilateral plus axial involvement
Stage 2 = Bilateral disease without impairment of balance
Stage 2.5 = Mild bilateral disease with recovery on “pull test”
Stage 3 = Mild to moderate bilateral disease; some postural instability; physically independent
Stage 4 = Moderate to severe bilateral disease; frequent loss of balance; 50% physically dependent
Stage 5 = Non-ambulatory; 80-100% dependent ADLs
What stage is important in terms of motor instability/falling?
stage 3
fall risk
mild-mod bilateral
some postural instability
physically independent
FOG usually at stage 3
Differential Dx of PD
- Essential tremor: intention –> no non motor ss, or balance problems, impacts voice, drinking from a cup, shaky handwriting
- PSP: progressive supranuclear palsy
- MSA
- Vascular Parkinsons
- CGD corticobasal ganglionic degeneration
in order of severity leas tto worst
What are 5 features supporting IPD diagnosis
- unilateral symptom onset
- resting tremor
- narrow based gait, flexed/stooped posture
- reduced arm swing with TREMOR
- sustained, significant levadopa effect
features of PARKINSONISM
- symmetry at onset
- rapid progression
- lack of tremor
- falls (early)
- early dysautonomia (BP, GI, GU issues)
- POOR RESPONSE TO LEVODOPA
FIGS acronym
you can differentiate PSP from IPD by if they:
1. F (frequent, early falls)
2. ineffective meds
3. gaze stability
4. speech/swallow changes
What is the gold standard for Parkinson’s outcome measure
UPDRS
Unified Parkinson’s Disease Rating Scale
*not that sensitive to subtle changes
What are the core measures for PD by APTA
Highly recommended:
1. 6 min walk
2. MiniBEST
3. 10 meter walk
4. FGA
5. 5x STS
6. MDS-UPDRS
7. 9 hole peg test
Recommended for specific constructs
6. ABC: fear of falling
7. TUG Cognitive: dual tasking
8. Parkinson’s Fatigue scale
9. Freezing of Gait Questionaire
not finished
