Parkinsons (2)

Question 1

What are characteristics of idiopathic Parkinson’s?

Answer 1

Early onset <50 years old

Tremor dominant or postural imbalance and gait disorder dominant

Question 2

What are characteristics of secondary Parkinsonism?

Answer 2

External cause (drug induced, toxins, infectious, tumor, or trauma)

Question 3

What are characteristics of atypical Parkinsonism (parkinson plus)?

Answer 3

Progressive supranuclear palsy

Corticobasilar degeneration

Multiple system atrophy

Dementia with Lewy body

Question 4

What are some characteristics of progressive supranuclear palsy?

Answer 4

Eye movement abnormalities (loss of downward gaze)

Broad based gait, ataxic, and arms abduct

Question 5

What are some characteristics of corticobasilar degeneration?

Answer 5

Apraxia

Cortical sensory loss

Myoclonus

Question 6

What are some characteristics of multiple system atrophy?

Answer 6

Autonomic dysfunction

Abnormal postures

Question 7

What are some characteristics of dementia with Lewy body?

Answer 7

Dementia and visual hallucinations

Question 8

How do symptoms progress in atypical parkinsonism?

Answer 8

Faster

Question 9

What are the risk factors of Parkinson’s?

Answer 9

Age > 60

Males

Positive family history (genetics)

Question 10

What are prodromal markers of neurodegenerative process?

Answer 10

REM sleep behavior disorder

Depression

Autonomic dysfunction

Question 11

What % is loss before a Parkinson’s diagnosis?

Answer 11

80%

Question 12

What are the key symptoms of Parkinson’s?

Answer 12

Rigidity

Bradykinesia

Postural instability

Tremor

Question 13

What can levodopa treatment lead to?

Answer 13

Dyskinesia (impairment of voluntary movement)

Question 14

What is camptocormia dystonia?

Answer 14

Thoracolumbar flexion (due to overactive rec fem)

Question 15

What is pisa syndrome?

Answer 15

Truncal dystonia (lateral trunk flexion)

Question 16

What is feet dystonia?

Answer 16

Flexion of toes and inversion of ankle

Question 17

What % of Parkinson’s patients report pain?

Answer 17

95%

76% interfering with daily life

Question 18

Where is most pain present in Parkinson’s?

Answer 18

Back

Joint

Nerve

Question 19

What are the cognitive effects of Parkinson’s?

Answer 19

Difficulty changing cognitive or motor set with change

Affects response inhibition

Impairs automaticity of movement

Question 20

What does performing cognitive tasks increase in those with Parkinson’s?

Answer 20

Fall risk

Question 21

What is a consideration when taking meds for Parkinson’s?

Answer 21

Do not take with protein (decreases absorption)

Question 22

When do you want to work with Parkinson’s patients?

Answer 22

During their ON time (after they take medication)

Question 23

What is deep brain stimulation?

Answer 23

Delivery of high frequency stimulation to basal ganglia (overrides neuronal activity in basal ganglia)

Question 24

Will people that have a good response to levodopa have a good response to deep brain stimulation?

Answer 24

Yes

Question 25

Why do patients need to wait 5 years to do deep brain stimulation?

Answer 25

DBS will make Parkinson’s plus worse

Question 26

When should DBS be considered?

Answer 26

If tremor is predominant

Question 27

What can get worse with DBS?

Answer 27

Walking and balance Speech and swallowing Cognition

Question 28

What improves with DBS?

Answer 28

Tremor Rigidity Slowness Dyskinesias Less on/off fluctuations

Question 29

What is the modified Hoehn and Yahr scale?

Answer 29

1- unilateral involvement only 1.5- unilateral and axial involvement 2- bilateral involvement without impairment of balance 2.5- mild bilateral disease with recovery on pull test 3- mild to moderate bilateral disease 4- severe disability (still able to walk or stand unassisted) 5- wheelchair bound

Question 30

When do you start taking medication for Parkinson’s according to modified Hoehn or Yahr scale?

Answer 30

At 2.5

Question 31

Why do PwP have more injurious falls?

Answer 31

They pull their arms in

Question 32

Why is a fall most commonly forward and onto the knees when walking in PwP?

Answer 32

Feet freezing

Question 33

What way to PwP fall when standing?

Answer 33

Backwards

Question 34

What are continuous gait disorders in Parkinson’s?

Answer 34

Reduced arm swing, step length, and gait speed Postural deformities Slow turns

Question 35

What are episodic gait disorders in Parkinson’s?

Answer 35

Freezing of gait Festinuating gait

Question 36

What is freezing of gait due to?

Answer 36

Poor coupling between anticipatory postural alignment and stepping (small shuffling steps)

Question 37

Where are feet placed involuntary on festinating gait?

Answer 37

Behind COG with rapid small steps (propelled up on toes)

Question 38

Why does festinating gait result in forward falls?

Answer 38

Upper body is propelled forward

Question 39

What are the strength training recommendations for Parkinson’s patients?

Answer 39

Large extensor groups 3x a week

Question 40

What are the aerobic training recommendations for Parkinson’s patients?

Answer 40

Large amplitude movement at moderate intensity 5x a week

Question 41

What are the flexibility training recommendations for Parkinson’s patients?

Answer 41

Cervical and axial muscles 2x a week

Question 42

What are the balance training recommendations for Parkinson’s patients?

Answer 42

1-3x a week for 30 minutes

Question 43

What do Parkinson’s patients need to do as soon as possible?.

Answer 43

Exercising

Question 44

What are the benefits of exercising in Parkinson’s patients?

Answer 44

Increased availability of dopamine Increase in protective factors