CH 16: Parkinsons

Question 1

Preclinical sx of Parkinson’s

Before the diagnosis of Parkinson’s is made

Answer 1

• Constipation
• Decreased taste and smell
• Sleep difficulties (REM and RLS)
• Decreased facial expression, soft/flat voice, passive personality
• Late-onset depression

Question 2

Early sx of Parkinson’s

Answer 2

• decreased arm swing or stride length on one side (leading to shoulder or hip pain)
• Difficulty closing buttons, clasps (slow to get ready in AM)
• Repetitive movements slow and get smaller (ie toothbrushing, handwriting)
• Tremors only intermittent during stresful situations at first
• Initially, motor sx may be attributed to weakness or stiffness of limbs

Question 3

The PD tremor

Answer 3

• starts intermittent, progressive to obvious and constant
• may be absent altogether in some (especially if later age onset)
• typically present only at rest
• some pepole control it by always keeping hands active

Question 4

Motor features of PD

Answer 4

• Resting tremor
• difficulty initiating movement
• worsening balance
• Akinesia (lack of movement)
• Bradykinesia (slow movement)
• stopoped posture

Question 5

Psychiatric features

Answer 5

Depression
Anxiety
Apathy
Dementia
Hallucinations
Impulse control disorders

Question 6

Autonomic features

Answer 6

Constipation
Orthostasis (lightheadedness on standing)
Excessive sweating
Urinary incontinence

Question 7

Sleep disorders

Answer 7

Insomnia
Rapid eye movement behavior disorder
Restless legs syndrome
Excessive daytime sleepiness
Fatigue

Question 8

Sensory features

Answer 8

Impaired sense of smell and taste
Blurred vision
Numbness and tingling
Pain

Question 9

strategies to overcome “motor freezing”

The feeling of feet glued to the floor

Answer 9

• Medications and surgery dont really work for this
• walkers/ canes with a laser making a red line for pt to step over
• walking to a rhythm / marching song

Question 10

strategies for low voice colume

Answer 10

The SPEAK OUT and Lee Silverman Voice Therapy (LSVT) LOUD programs

Question 11

Risk factors for PD

Answer 11

• pesticides (like Rotenone)
• chlorinated solvents (like Trichloroethylene in some household agents!)
• heavy metals
• some dairy products
• well water

Higher prevalence of PD in rural areas

Question 12

Protective factors

Answer 12

• cigarettes (but nicotine patches dont slow rate of progression)
• coffee (but caffeine doesnt slow rate of progression)
• diets rich in flavanoids

Question 13

composition and location of Lewy Bodies

Answer 13

Intraneuronal inclusions in the dopaminergic neurons of the brainstem, substantia nigra

Contain alpha-synuclein bound to ubiquitin (a chaperone protein). But unbound alpha-synuclean may be more harmful to neurons!

Question 14

Braak hypothesis

Answer 14

Lewy bodies start in olfactory bulb and dorsal motor nucleus of vagus nerve –> spread rostrally fro the medulla –> years later the substantia nigra is severely affected

Suggests a pathogen progressing from cell to cell. THis is Braak hypothesis.

Of note: It may be that the unbound alpha-synuclean, when misfolded, transmits the pathologic condition and is like an infectious agent. Misfolded alpha synuclean may also play a role in mitochondrial dysfunction (evidence of mitochondrial complex I damage in PD)

Question 15

Nutrition recs for PD

Answer 15

• High fiber diet, for constipation
• High omega-3 dietary consumption (one study in Netherlands showed plant-based ALA consuption reduced risk of PD. Other studies showed improved mood sx or dyskinessias with fish oil)
• Colorforl fruits and veggies for antioxidants
• Plenty of fluids for good hydration