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Neurological D & D Exam 1 > 5. PD, Huntington's, and Dystonia > Flashcards

5. PD, Huntington's, and Dystonia Flashcards

1
Q

PD signs and symptoms Main 4

A

Resting tremor
Bradykinesia
Rigidity
Postural Instability

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2
Q

Resting tremor rate pathological vs non

A

4-6 pathological

8-12 non

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3
Q

Resting tremor

A

Tremor when body weight supported this is more common in early Parkinson’s

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4
Q

Intention tremor

A

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

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5
Q

Rigidity

A

Cogwheel

Leadpipe

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6
Q

Parkinsons symptoms

A

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

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7
Q

PD- Posture

A

Kyphotic, forward flexed trunk
Forward head
Crouched legs

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8
Q

PD- Gait Deficiency

A 
difficulty initiating
freezing gait
festinating gait
Decrease trunk rotation
Decrease arm swing
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9
Q

PD progression

A

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)

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10
Q

Hoehn & Yahr- Stage 1

A

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

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11
Q

Hoehn & Yahr- Stage 2

A

Bilateral, both sides of the body
Minimal disability
Posture and gait affected

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12
Q

Hoehn & Yahr- Stage 3

A

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

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13
Q

Hoehn & Yahr- Stage 4

A 
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
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14
Q

Hoehn & Yahr- Stage 5

A

Cachectic stage: loss of weight and muscle wasting secondary to serious disease or disorder:
Invalidism complete
Cannot stand or walk
Requires constant nursing care

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15
Q

PD diagnoses

A

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

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16
Q

PD meds- Ldopa

A

Levodopa (L-dopa)
A dopamine precursor that crosses the blood-brain barrier and then converts to dopamine
aim is BG

17
Q

Ldopa Side effects

A

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

18
Q

PD meds- carbidopa

A

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

19
Q

Carbidopa effects

A

Therapeutic Effect: decreases symptoms of Parkinson’s less muscle rigidity, less bradykinesia

20
Q

carbidopa side effects

A

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

21
Q

PD Ablation (stereotaxic surgery)

A

Selectively destroying specific cells that contribute to the symptoms
Pallidotomy (reduce tremor, rigidity, and bradykinesia)
Thalamotomy (reduce tremor)

22
Q

PD DBS

A

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

23
Q

PD: hypokinetic

A

SUBSTANTIA NIGRA PARS COMPACTA IMPAIRED TO RELEASE DOPAMINE  UNDERFACILITAED CORTEX  HYPOKINETIC

24
Q

Huntingtons

A

Dominant genetic disease
Degeneration of SNr & LGP
Hyperkinetic

25
Q

Huntingtons onset and progression

A

Onset: 30 YOA
Death: 15-20 years later

26
Q

Non huntingtons chorea like movements

A

children who have had anoxia or cerebral palsy

Medicated PD patients

27
Q

Huntingtons symptoms

A 
Chorea
Akinesia and bradykinesi
HYPOTONIA
staggering gait
speech lacks rhythm
swallowing difficulty
poor saccadic control
28
Q

Huntingtons cognitive symptoms

A 
Dementia
Poor judgment
Loss of long term memory
Depression
IQ decreases
Irritability
29
Q

Huntingtons early stage

A

MOTOR SYMPTOM BEGIN DISTAL
Cognitive difficulty thinking through complex tasks
Behavioral: irritability and disinhibition

30
Q

Huntingtons midstage

A

Losing independence: may be unable to perform chores work or drive
Motor: eating becomes a challenge
Cognitive: cannot organize info
Behavioral: losing interest

31
Q

Huntingtons late stage

A

Totally dependent for all care, combined to bed, SNF
Unable to speak
Tube feeding, choking concerns
Motor: severe rigidity, chorea stopped, cannot initiate
Behavioral: some have psychosis

32
Q

Huntingtons Medications

A 
Cholinergic or GABA-containing agonists
Perphenazine
Haloperidol (Haldol)
Reserpine
Riluzole
33
Q

Dystonia

A 
Idiopathic
early onset has a defected gene
OFTEN SECONDARY TO OTHER DISORDERS
Lesions at caudate, putamen or globus
Hyperkinetic
34
Q

Dystonic movements

A

abnormal muscle tone with simultaneous contraction of agonist and antagonist
Co-contraction of muscles around a joint causes the joint to be rigid

35
Q

Dystonia: Focal: pharyngeal

A

intercostals and diaphragm often affected
Distorted speech
Treated with botox

36
Q

Dystonia progression onset: generalized

A

8 YOA

Begins in legs

37
Q

Dystonia progression onset: focal

A

30-50 YOA

Progresses for 5 years and then plateaus

Neurological D & D Exam 1 (5 decks)

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