Case 7 - Clinical Features of Parkinsons

Question 1

what is the triad of symptoms

Answer 1

tremor, rigidity and bradykinesia

Question 2

what is the usual features of a PD tremor

Answer 2

usually of the hand at 4-7Hz
disappears with deliberate activity
pin-rolling tremor at rest

Question 3

what two circuits is a tremor linked to

Answer 3

the basal ganglia, which are primarily affected by dopamine depleted in PD
the cerebello-thalamo-cortical circuit which is also involved in many other tremors

Question 4

what is a resting tremor recurrent with posture known as

Answer 4

re-emergent tremor

Question 5

what are the neurological basis for PD resting tremor

Answer 5

involves dopaminergic cell loss in the substances nigra pars compacta, particularly in the lateral ventral tier

this leads to dopamine depletion in the striatum particular in the dorsolateral putamen

these changes are strongly linked to bradykinesia

Question 6

where is rigidity usually present

Answer 6

the neck and axial muscles

Question 7

is rigidity equal in flexors and extensors

Answer 7

yes

Question 8

what is lead pipe rigidity

Answer 8

defined as a constant resistance to motion throughout the entire range of motion

Question 9

what is cogwheel rigidity

Answer 9

to resistance that stops and starts as the limb is moved through its range of motion

as the rigidity temporarily gives in certain ranges of movement, as you move the cog

Question 10

what is akinesia

Answer 10

difficulty in initiating movement

there is a characteristic decrease in spontaneous blink rate and in facial expression

speech is poorly articulated and the voice quiet and monotonous

eating and swallowing become incredibly difficult

Question 11

what is characteristic in posture of someone with PD

Answer 11

stooping

Question 12

what happens to the gait

Answer 12

becomes hurrying and shuffling with poor arm swinging

Question 13

what does the gait have

Answer 13

narrow base

Question 14

list of gait alterations

Answer 14

lack of heel stroke
incomplete knee extension during stance phase
inability to extend the knee and flex the Ankle in terminal space
forward trunk lean
lack of motion in the trunk
reduced or absent arm swing
decreased toe clearance
reduced speed and amplitude

Question 15

what is freezing of the gait

Answer 15

periodic inability to generate effective stepping
it is consistently seen as one of the most disabling symotms of PD
feet are ‘stuck’ to the floor despite attempts to force themselves to walk
increases with duration of the disease

Question 16

how is freezing of gait triggered

Answer 16

at the onset of walking and during turning, but also when confronted with narrow spaces or when approaching targets

Question 17

how long does freezing of gait last

Answer 17

usually less than 10 seconds but can last as long as 30 seconds

Question 18

what is bradykinesia

Answer 18

defined as slowed voluntary movement, although we now know that rigidity also effects autonomic movements such as arm and leg swinging during gait

Question 19

what are the theories of bradykinesia

Answer 19

one suggests that it is a compensatory response, intended to slow down voluntary movement and improve movement accuracy

another suggests that it is caused by a deficit in force production

Question 20

what kind of motor movements are the worst effected

Answer 20

fine motor movements

Question 21

what are some red flags for idiopathic PD diagnosis

Answer 21

absent tremor, symmetrical onset
early gait abnormality and falls
pyramidal tract signs
poor levodopa response
PSP
MSA
CBS
early dementia