5. PD, Huntington's, and Dystonia Flashcards
PD signs and symptoms Main 4
Resting tremor
Bradykinesia
Rigidity
Postural Instability
Resting tremor rate pathological vs non
4-6 pathological
8-12 non
Resting tremor
Tremor when body weight supported this is more common in early Parkinson’s
Intention tremor
Intention tremor (part of cerebellar disease not PD) is when the tremor is small in amplitude to begin with and increases as approach closer to target
Rigidity
Cogwheel
Leadpipe
Parkinsons symptoms
Difficulty with swallowing and chewing
Speech impairments: Speak too softly, monotone, hesitant, slurred, repeating words
“Masked” face (flat affect)
Fatigue
Sleep problems
Decreased strength in muscles of respiration
Dementia or other cognitive problems
PD- Posture
Kyphotic, forward flexed trunk
Forward head
Crouched legs
PD- Gait Deficiency
difficulty initiating freezing gait festinating gait Decrease trunk rotation Decrease arm swing
PD progression
In the later stages of the disease, PD-related complications can lead to death, such as choking, pneumonia, and falls
Progression of symptoms may take 20 years or more (In some, PD progresses more quickly)
Hoehn & Yahr- Stage 1
Unilateral, one side of the body
Symptoms mild, inconvenient but not disabling
Usually presents with tremor of one limb
Friends noticing change in posture, gait, facial expression
Hoehn & Yahr- Stage 2
Bilateral, both sides of the body
Minimal disability
Posture and gait affected
Hoehn & Yahr- Stage 3
Significant slowing of movement
Early impairment of equilibrium on gait or standing
Generalized dysfunction that is moderately severe
By the time people reach Stage 3, quality of life is usually significantly affected
Hoehn & Yahr- Stage 4
Severe symptoms Can still walk to a limited extent Rigidity and bradykinesia No longer able to live alone Tremor may be less than earlier stages
Hoehn & Yahr- Stage 5
Cachectic stage: loss of weight and muscle wasting secondary to serious disease or disorder:
Invalidism complete
Cannot stand or walk
Requires constant nursing care
PD diagnoses
Must have two or more classical signs
Positive response to dopamine-like medications
CT or MRI in PD usually appear normal, but may be needed to rule out other diseases
PD meds- Ldopa
Levodopa (L-dopa)
A dopamine precursor that crosses the blood-brain barrier and then converts to dopamine
aim is BG
Ldopa Side effects
Nausea, Hypertension, Dyskinesias
“Tolerance” develops with continued usage
Period of effectiveness after each dose begins to shorten
Larger doses may be needed to be effective
PD meds- carbidopa
Carbidopa: inhibits Dopa decarboxylase, prevents premature conversion in the bloodstream
Often 4:1 ratio of carbidopa to levodopa (sometimes 10:1 ratio)
Carbidopa does not cross the BBB which is good since do not want levadopa to not convert to dopamine once it is in the brain
Carbidopa effects
Therapeutic Effect: decreases symptoms of Parkinson’s less muscle rigidity, less bradykinesia
carbidopa side effects
GI irritation: severe nausea and vomiting with initial administration
Postural hypotension/orthostatic hypotension
Cardiac arrhythmias
Large incidence of dyskinesias (chorea-athetoid movements)
Psychosis(limbic system), depression, anxiety
PD Ablation (stereotaxic surgery)
Selectively destroying specific cells that contribute to the symptoms
Pallidotomy (reduce tremor, rigidity, and bradykinesia)
Thalamotomy (reduce tremor)
PD DBS
Deep brain stimulation (DBS)
Electrodes implanted in thalamus, subthalamic nucleus, and globus pallidus
Electrodes connected to a pulse generator
The pulse generator and electrodes painlessly stimulate the brain
Blocks electrical signals from targeted areas
Reduces the need for medications
PD: hypokinetic
SUBSTANTIA NIGRA PARS COMPACTA IMPAIRED TO RELEASE DOPAMINE UNDERFACILITAED CORTEX HYPOKINETIC
Huntingtons
Dominant genetic disease
Degeneration of SNr & LGP
Hyperkinetic
