PD

Question 1

PD is the a common neuro disorder second only to what condition

Answer 1

Alzheimer’s

Question 2

PD is the most common _____ disorder

Answer 2

movement

Question 3

Generally when is PD diagnosed

Answer 3

50-60 years

Question 4

what is the primary cause of PD

Answer 4

most cases are idiopathic

Question 5

though PD as we traditionally talk about it is generally idiopathic, what are three common causes of Secondary Parkinsonism?

Answer 5

postencephalitic parkinsonism
toxic parkinsonism
drug-induced (haldol) parkinsonism

Question 6

What are the three common categories of PD

Answer 6

1. PD
2. Secondary Parkinsonism
3. Parkinson-Plus Syndromes (atypical PD)

Question 7

what anatomy is implicated in PD?

Answer 7

the basal ganglia

Question 8

what role does the BG play in PD?

Answer 8

voluntary movement and postural adjustments - i.e. the dog leash that pulls in or lets out motor function

Question 9

What is the pathophys of PD

Answer 9

dopaminergic neuron degeneration

Question 10

T/F: patients will begin to demonstrate sxs of PD as dopaminergic neurons degenerate

Answer 10

false: patients will not show clinical sxs until 60-80% degeneration

Question 11

How can a clinician distinguish between Parkinson Disease Dementia and Lewy Body Dementia?

Answer 11

PDD presents as PD then cognitive changes follow at least 1 year after dx. LBD presents as PD with concurrent cognitive changes within 1 year of dx.

Question 12

what are the four cardinal features of PD

Answer 12

1. bradykinesia
2. tremor
3. rigidity
4. postural instability

Question 13

describe bradykinesia as a cardinal sign of PD

Answer 13

the most common cardinal feature that can present as festinating gait, micrographia, hypomimia (masked facies), and/or freezing episodes

Question 14

describe tremor as a cardinal feature of PD

Answer 14

the first cardinal symptom in 50% of patients most often seen as a pill rolling resting tremor

Question 15

describe rigidity as a cardinal feature of PD

Answer 15

1. velocity independent
2. reflexes may be normal
3. cogwheel - stopping/catching throughout ROM
4. lead pipe - pushing through constant arc of motion resistance
5. trunk rigidity

Question 16

describe postural instability as a cardinal feature of PD

Answer 16

difficulty in anticipatory movement and posture shifted anteriorly

Question 17

what does it take to clinically dx PD?

Answer 17

2/4 cardinal features and dx of exclusion - though imaging (DaTSCAN, PET, SPECT) is becoming more popular/useful

Question 18

What are the three most common Parkinson Plus Syndromes

Answer 18

1. Progressive Supranuclear Palsy
2. Corticobasilar Degeneration
3. Multiple System Atrophy (Shy Drager Syndrome)

Question 19

What is Progressive Supranuclear Palsy (PSP)

Answer 19

1. a clinical mimic of PD but dominated by frontal lobe sxs
2. Hallmark signs - rocket sign (forcefull STS followed by a push back) and inability to gaze downward (looking up a lot)

Question 20

What is corticobasal degeneration

Answer 20

1. clinical mimic of PD BUT PD MEDS DONT HELP

2. remarkable rigidity and ataxia

Question 21

What is the key to understanding multiple system atrophy (Shy Drager Syndrome) as an offshoot of PD?

Answer 21

Autonomic presentation is key (dizziness, fainting, orthostasis)

Question 22

Discuss the course of disease for PD

Answer 22

though pathology precedes dx by years, tremor dominant PD has a better prognosis and can be rather benign

Question 23

what is the mainstay medical tx for PD

Answer 23

Sinemet (levadopa and carbidopa) - i.e. dopamine replacement therapy

Question 24

describe the implication of dopamine replacement therapy

Answer 24

impact deteriorates over the course of the disease resulting in an on-off phenomenon therefore some patients take drug holidays

Question 25

T/F: there is no surgical management for PD

Answer 25

false: DBS can significantly improve function in PD patients

Question 26

what are two postural deformities/dystonias that are common in PD patients

Answer 26

1. camptocormia - bent spine syndrome (flexed in sagittal plane) 2. pisa syndrome - lateral spinal flexion (frontal plane)

Question 27

what are two measures specific to PD

Answer 27

H&Y and UPDRS

Question 28

how do you address the phantom pillow phenomenon in PD patients?

Answer 28

prone tasks

Question 29

what should you do to combat postural changes in PD patients

Answer 29

tai chi, rocking and rotation movements, PNF patterns

Question 30

what intensity of task specific training (functional mobility, balance, gait) is appropriate for PD patients

Answer 30

high

Question 31

what are ideas to combat trunk/pelvis stiffness in PD patients

Answer 31

pelvic clock, swiss ball, bridging, scooting

Question 32

what is a good idea to help encourage dopamine uptake during exercise

Answer 32

large amplitude movement

Question 33

T/F: treadmill training is inappropriate for PD patients

Answer 33

false - high intensity training is recommended

Question 34

what is a strategy you can use with PD patients to make their movements more effective?

Answer 34

external cues (such as auditory or visual cues) engage CB and cortical areas of the brain

Question 35

T/F: high intensity exercise is neuroprotective in PD patients, not neurodegenerative

Answer 35

true

Question 36

though Tai Chi does not have any evidence to support impact on gait and QoL, what does it do?

Answer 36

it is safe, popular, and has a positive effect on motor function and balance

Question 37

what type of AD could be most beneficial for PD patients

Answer 37

U-step walker

Question 38

Research says that THIS adjuvant to exercise and rehab improves symtpoms of PD

Answer 38

forced exercise cycling/theracycle - which mechanically augments exercise rate greater than the preferred voluntary rate