Assessing Parkinson's disease

Question 1

Assessing Pakinson’s disease

what is typically used and how

Answer 1

• Unified Parkinson’s disease rating scale: widely used by neurologists and speciality clinics
• Modified Hoehn and Yahr scale: general staging of symptoms and function
• postural control, balance, and gait measures: TUG, mini-BEST, 6MWT, functional Gait assessment

Question 2

Dietary considerations for Parkinson’s disease

Answer 2

• high calorie, low protein: protein can interfere with absorption of levodopa
• anti-inflammatory diet may help
• a whole foods plant-based diet may help

Question 3

Huntington’s disease

Answer 3

• Genetic disorder
• symptoms: chorea (rhythmic), athetosis, possible Dementia (brain starts to lose brain matter)

Question 4

Changes in HD

pathophyiology

Answer 4

• degeneration: decrease activity in output nuclei
• disinhibition of thalamus &PPN (over activated)
• increase activity in lateral tracts

Question 5

Examination and interventions

HD

Answer 5

• examination: similar to parkinsons
• intervention: compensatory strategies, weight bearing and approximation, task completion with decreased effort, exercise

Question 6

Other disorders

movement disorders realted to parkinsons

Answer 6

• Hemiballismus: stroke, Flinging of UE/LE
• choreoathetoid CP: Damage to Basal ganglia
• dystonia
• tourette’s syndrome
• tardive dyskinesia and parkinsonian syndromes
• secondary parkinsonism
• progressive supranuclear palsy and other parkinson-plus disorders

Question 7

Dystonia

what is it/causes

Answer 7

• sustained muscle contractions
• twisting, repetitive movements, postural changes
• ex: writer’s cramp, foot cramps, torticollis
• causes: idiopathic, overuse, aberrant learning, inherited, medication (sinemet)

Question 8

Dystonia Treatment

Answer 8

• PT: motor re-learning, relaxation, biofeedback (teach them to relax)
• Meds: botox, baclofen, benzodiazepines, anticholinergics, dopamine-blocking agents
• Surgery: pallidotomy (globus pallidus), thalomotomy (thalamus), deep brain stimulation, myectomy, Rhizotomy (dorsal root), peripheral denervation

Question 9

Tardive dyskinesia

Answer 9

• drug induced: esp Ca channel blockers
• postural changes: flexed forward
• comming off medications can sometimes get to go away completely

Question 10

Tourette’s syndrome

Answer 10

• inherited
• tics - motor and vocal
• interventions: biofeedback, relaxation, BoTox, medical cannabis

Question 11

Secondary parkinsonism: toxic parkinsonism

Answer 11

• industrial toxins eg: manganese
• synthetic heroin
• drug induced: neuroleptics, antidepressants, antihypertensives

Question 12

Parkinson- plus syndromes: Neurodegenerative disease

Answer 12

• progressive supranuclear palsy: racoon eyes + CN 2 & progressive

Multiple System atrophy:

• striatonigral degeneration: most similar to parkinsons
• olivopontocerebellar atrophy: more balance issues
• cortical-basal ganglionic degeneration: difficult with BP

Question 13

Parkinson-Plus Syndrome: other causes

Answer 13

• Mutli-infarct vascular disease (series of small strokes)
• alzheimer’s disease
• diffuse lewy body disease
• normal pressure hydrocephalus (Wet, wacky, wobbly)
• Wilson’s disease
• juvenile huntington’s disease

Question 14

Fail the apomorphine test

Answer 14

• limited or no improvement with L dopa

Question 15

Metabolic causes of parkinsonism

Answer 15

• often related to calcium metabolism
• calcification of basal ganglia
• hyperparathyroidism
• hypothyroidism

Question 16

other movement disorders

somewhat unrelated to PD

Answer 16

• restless leg syndome
• essential tremor