406 E2 - Parkinsons Flashcards
Parkinson Disease Definition
a progressive, degenerative disorder of basal ganglia function
what are the basal ganglia
-function w/ cerebellum to make smooth, coordinated movement
-the substantia nigra in the basil ganglia has cells that produce dopamine this is the part we are most concerned with
Parkinsonism: primary
-idiopathic = parkinson’s disease
-genetic or sporadic
Parkinsonism: secondary
acquired by: infection, intoxication, trauma & drug induced
parkinson’s disease risk factors
-age: >60, peak @ 70
-gender (male)
-genetic: both dominant and recessive
emerging risk factors for parkinson’s disease
-environmental exposures
-depression
-head trauma
-hysterectomy
-coffee consumptions (non consumption)
neurotransmitters
enable neurotransmission -> essentially they communicate between the neurons and they travel across the synapses and either block or facilitate the relay of the stimulus
dopamine has what type of effect
inhibitory and excitatory -> depends one what type of receptor it binds to
what type of dopamine effect is lacking with Parkinson’s disease?
inhibitory effects
how does dopamine work
helps muscles work smoothly, controllably and without unwanted movement by inhibiting unnecessary movements
increases coordination, balance and muscle control
acetylcholine (ACH) is what type of neurotransmitter
excitatory
what does acetylcholine do
stimulates muscle movement and can cause uncoordinated movement
essential for muscle function and works w/ dopamine in a balanced state
if dopamine levels decline and acetylcholine levels stay the same, what happens to muscle movement
coordinated muscle movement decreases
in parkinson’s what is the relationship ration between dopamine & ACH
too much ACH in relation to dopamine -> resulting in loss of coordinated movement
what happens to dopamine in primary Parkinson’s
there is damage to the dopamine producing cells
what happens to dopamine in secondary Parkinson’s
there is an alteration in production of dopamine (ex: infection, drug, head trauma)
primary parkinson’s pathogenesis
destruction of substantia nigra in basal ganglia -> dopamine levels decrease -> imbalance between dopamine & ACh -> relative excess of ACh -> loss of controlled movement and balance
clinical manifestations of Parkinson’s Disease
-bradykinesia (slowness of movement)
-cogwheel rigidity (stiff muscles)
-resting tremor (pill rolling tremor)
-shuffling gait
-mask like expression
-postural instability
-loss of balance
onset on parkinsons symptoms
gradual onset and progression
-may only involve 1 side of the body at first
what is the classic triad of parkinson’s manifestations
-rest tremor
-rigidity
-bradykinesia
what is usually the first sign of parkinson’s
tremor
tremor in parkinson’s
-handwriting effected
-more prominent at rest
-aggravated by stress or concentration
-“pill roll”
differentials between a parkinson’s tremor vs essential tumor: essential
-results from faulty neurological impulses
-tremors occur w/ motor function
-no other manifestations of parkinson’s disease
differentials between a parkinson’s tremor vs essential tumor: parkinson’s
-results from dopamine deficiency
-tremors occur w/ rest and improve w/ movement
-presents w/ other manifestations of parkinsons disease
rigidity
resistance to passive movement
“cogwheel rigidity”
movements are jerky and slow
why does rigidity occur
-sustained muscle contraction
-too much ACh in comparison to dopamine
rigidity is associated w/
muscle soreness, aches & pain
muscles don’t get to relax
bradykinesia
loss of automatic movement (aka spontaneous movement)
major cause of disability in parkinson’s
examples of bradykinesia
-no blinking
-no swinging of arms
-no swallowing of saliva (drooling)
-no self expression w/ hands & face
postural instability
a decreased ability to prevent falling caused by impairment of centrally mediated postural reflexes
gait disturbances seen in parkinson’s
shuffle or short stepped gait
parkinson’s disease: complication
-dementia (40%)
-sleeping disturbances
-fatigue
-depression/anxiety
-decreased mobility (malnutrition, pneumonia, UTI’s, skin breakdown)
-drug related complications
why do people with parkinson’s get malnutrition
d/t difficulty preparing meals and feeding themselves
