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Patho 2 > Degenerative Diseases > Flashcards

Degenerative Diseases Flashcards

1
Q

How many people in the US have Parkinson’s? What happens to incidence with age?

A

~1.5 million people with PD in the US

Incidence increases with age

10% onset before 40 y.o.

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2
Q

PD is what kind of disease? What causes it?

A

Is a neurochemical disorder

Substantia nigra loses dopamine producing ability. Up to 80% loss before symptoms!

Leads to a disinhibition of the cholinergic system

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3
Q

Etiology

A

Mostly idiopathic (family history + risk factor)

Can also be due to encephalitis, toxic encephalopathy, other degenerative basal ganglia diseases

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4
Q

PD - TRAPPED

A

T- tremor
R- rigidity
A- Akinesia/Bradykinesia
P- Postural instability

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5
Q

What causes the tremor and rigidity?

A

Excessive cholinergic activity

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6
Q

What causes the a/bradykinesia?

A

Loss of dopamine

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7
Q

What is the most common presenting problem in PD patients? How does it start?

A

Tremor

Starts unilaterally

Typically first seen in fingers: “pill rolling”

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8
Q

Characteristics of PD tremor include: (5)

A

Is present at rest, and often disappears with limb movement

Increases with exertion or tension

Decreasesor disappears with sleep

Has a frequency of 4-7 Hz

Typically spreads over time

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9
Q

What is rigidity? Name two types of rigidity.

A

A non-velocity dependent increased resistance to PROM

Lead pipe vs. Cog wheel

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10
Q

Characteristics of Rigidity: (2)

A

Appears unilaterally before bilaterally

An early sign: loss of arm swing in gait

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11
Q

What is Bradykinesia?

A

Paucity of movement

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12
Q

Characteristics of Bradykinesia: (3)

A

Characterized by an inability to perform purposeful movements

Difficulty producing accurate, quick or smooth movements leading to over or undershooting of
movement

Sequential or simultaneous movements most
affected

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13
Q

What is akinesia?

A

Difficulty with movement initiation

Initiation occurs with co-contraction of agonist and antagonist

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14
Q

What’s the difference between bradykinesia and akinesia?

A

Both are motor planning deficits, but are mediated by separate mechanisms and do not correlate with each other

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15
Q

What is akinesia associated with?

A

Associated with the assumption of fixed
postures

a.k.a. “freezing”

Increased frequency in tight/enclosed spaced

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16
Q

Characteristics of PD Postural Instability and Fall Risk

A

Flexor bound posture (Often considered diagnostic)

INCREASED FALLS RISK! (Delayed equilibrium reactions, lack of anticipatory postural control, inability to adequately respond to perturbations)

17
Q

Characteristics of PD Gait

A

Festinating, shuffling gait and
retropulsion

Decreased heel strike and loss of heel, toe progression

Decreased step length

Loss of trunk rotation

Also impairs bed mobility

18
Q

PD Gait happens as a result of:

A

Combination of rigidity and bradykinesia

19
Q

Intellectual changes and dementia occurs in how many PD patients?

A

Occur in > 50% of individuals with PD

20
Q

PD Depression

A

1°: due to loss of dopamine neurons

2°: either reactive or due to sensory deprivation

21
Q

Other PD symptoms: (4)

A

Low, whispering monotone voice

Masked face

Lack of autonomic regulation leads to ↑ salivation and sebaceous secretions

Micrographia (Related to bradykinesia, 2° to inappropriate rate and scale of movements)

22
Q

Medical Management

A 
Dopaminergics 
Dopamine Agonists
Anticholinergics
MAO-B Inhibitors
COMT Inhibitors
Antiviral
23
Q

What are the side effects of dopaminergics?

A

Side effects include orthostatic hypotension, “on/off”
times, dyskinesia, hallucinations

Less effective over time

24
Q

What do dopamine agonists do?

A

Brain thinks there is more dopamine

Delays need for Sinemet, increaseduse for YOPD

Side effects: drowsiness, edema, obsessive problems

25
Q

What domapine agonist is used for severe off times?

A

Apokyn. You need an anti-nausea medication with this.

26
Q

What do anticholinergics do? What are the side effects?

A

Control tremor early on

Side effects: dry mouth, sedation, confusion, urinary retention

27
Q

What do MAO-B inhibitors do? What are the side effects?

A

Slow the breakdown of dopamine

Decreases free radical production from dopamine
metabolism

Reduce on/off time fluctuations

Side effects: orthostatic hypotension, insomnia

28
Q

What do COMT Inhibitors do? What are the side effects?

A

Blocks this enzyme that inactivates dopamine,
prolongs effective Sinemet time

Side effects similar to Sinemet

Patho 2 (5 decks)

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