Final: Parkinson's Impairments Flashcards
What are the 4 cardinal motor symptoms associated with Parkinson’s?
- Tremor
- Rigidity
- Bradykinesia
- Postural instability
What is a tremor?
Involuntary oscillations resulting from contraction of opposing muscles
What are the 3 characteristics of early stage tremor?
- Distal hand or foot
- One side of the body
- Resting tremor
What are the 4 characteristics of late stage tremor?
- Increased severity
- Bilateral
- Action tremor
- Interferes with ADLs
What is rigidity?
Increased resistance to passive motion
Is rigidity velocity dependent?
No
What is cogwheel rigidity?
Jerky, ratchet-like resistance
What is lead pipe rigidity?
Sustained rigidity
How does rigidity progress over the course of the disease?
Proximal to distal and unilateral to bilateral. Increased severity
What are secondary complications associated with rigidity?
Contracture, postural deformity, fatigue, increased energy expenditure
What is braykinesia?
Insufficient recruitment of muscle force and under scale internally generated movements. Slowness of movement resulting in both increased reaction and movement time
What is hypokinesia?
Decreased movement, smaller amplitude, less movement, micrographia, decreased arm swing
What is akinesia?
Absence of movement, freezing, no arm swing
What are balance impairments associated with Parkinson’s?
Decreased limits of stability, slow anticipatory adjustments, poor reactive balance
What are posture impairments associated with Parkinson’s?
Decreased activation of antigravity muscles, flexed posture, COM located towards the forward limits of stability
What % of Parkinson’s pt’s have had a single fall in the past year?
70%
What % of Parkinson’s pt’s have had multiple falls in the past year?
50%
What are gait deviations associated with Parkinson’s?
Slow pace, increased variability and symmetry, poor postural control, decreased step size, reduced arm swing, reduced anticipatory postural alignment, turn en bloc
What is festination?
Unintentionally rapid short steps
What is freezing of gait?
Trembling or absent movement with the transient inability to take a step that is triggered by confrontation with competing stimuli
What types of pain are common with Parkinson’s?
Musculoskeletal, dystonic, neuropathic, radicular, central, akathisia, hypersensitivity more common in off state of medication
Is there primary sensory loss associated with Parkinson’s?
No
What sensory impairments are associated with Parkinson’s?
Pain, perception of kinesthesia and proprioception, visual perceptual deficits, oculomotor changes, olfactory dysfunction
What is a hallmark early clinical sign of Parkinson’s?
Decreased or loss of smell
Why does dysphagia develop?
A result of rigidity and reduced movement
What does dysphagia affect?
Tongue control, chewing, bolus formation, swallowing, peristalsis
What complications are associated with dysphagia?
Choking, aspiration pneumonia, poor nutrition, weight loss, sialorrhea
What is hypokinetic dysarthria?
Decreased speech volume, monotone, imprecise articulation, uncontrolled rate of speech, hoarse
What two speech impairments are associated with Parkinson’s?
Hypokinetic dysarthria and mutism
What are contributing factors to speech disorders?
Motor symptoms including rigidity, hypokinesia, bradykinesia, tremor that impact muscles that control respiration, phonation, resonation, and articulation
What cognition impairments are associated with Parkinson’s?
Bradyphrenia, MCI, dementia, symptoms of levodopa toxicity
What is bradyphrenia?
Slowness of thought - is an early symptom
What is MCI?
Mild cognitive impairment - processing speed, set-shifting, attention, verbal fluency, planning, abstract reasoning, visuospatial, verbal, visual memory
What symptoms are indicative of levodopa toxicity?
Hallucinations, delusions, psychosis
What three sleep disorders are associated with Parkinson’s?
REM sleep behavior disorder, excessive daytime somnolence, insomnia
When does REM sleep behavior disorder occur?
Occurs prior to motor symptoms in 60% of individuals
What % of people with Parkinson’s experience depression?
40%
What % of people with Parkinson’s experience anxiety?
31%
What % of people with Parkinson’s experience apathy?
40%
What are neurobiological causes of decreased mental health in pt’s with Parkinson’s?
Alterations in the levels of dopamine, serotonin, norepinephrine. Apathy will improve initially with dopamine therapy
What is hypomimia?
Reduced facial expression that may be mistaken for depression or apathy
What are symptoms of autonomic dysfunction?
Impaired thermoregulation, slow pupillary response to light, decreased gastric motility, incontinence, blunted HR response to exercise, orthostatic hypotension, pulmonary dysfunction
What diagnostic test is used to medically diagnose Parkinson’s?
None - MRI used to rule out other causes and chemical markers can confirm dopamine deficits but are not specific to PD
What symptoms are characteristic of Parkinsonism?
Bradykinesia + tremor or rigidity
What are three keys to medically diagnosing PD?
- No symmetrical bilateral signs
- Rule out Parkinson-plus syndromes
- Clear and dramatic benefit from dopamine therapy
What is the MOA of Levodopa/Carbidopa?
Dopamine replacement. Carbidopa prevents levodopa from conversion to dopamine before it crosses the BBB
What is the MOA of a dopamine agonist?
Stimulate dopamine receptors in the basal ganglia
What is the MOA of COMT Inhibitors?
Blocks breakdown of dopamine to prolong effects and reduce “wearing off”
What is the MOA of MAO-B Inhibitors?
Blocks breakdown of dopamine to prolong effects and reduce “wearing off”
What is the MOA of Anticholinergics?
Reduces excessive acetylcholine influence. May reduce tremor and dystonia
What is the MOA of amantadine?
Antiviral. Blocks the effects of glutamate. May reduce dyskinesia
What is the MOA of norepinephrine precursors?
Increased norepinephrine levels. May reduce orthostatic hypotension
What is the MOA of Cholinesterase Inhibitors?
Inhibits acetylcholine breakdown. May improve memory function and gait instability
What is the MOA of atypical antipsychotics?
Blocks some effects of serotonin. Used to treat hallucination and psychosis side effects
What are common side effects of pharmacological management?
Wearing off, dyskinesia, dystonia, low BP, dizziness, nausea, dry mouth, insomnia, constipation
What is deep brain stimulation?
Electrodes implanted in the brain with a subclavicular impulse generator and controlled by an external controller
What are the two locations for electrode placement with a deep brain stimulator?
Subthalamic nucleus and globus pallidus internus
What is the effect of placing an electrode in the subthalamic nucleus?
Improve motor symptoms and tremor, reduce medication
What is the effect of placing an electrode in the globus pallidus internus?
Improve motor symptoms and tremor, suppression of dyskinesia
How effective is a deep brain stimulator?
Only an effective treatment for 10-20% of individuals who are considered good candidates
If a pt’s symptoms are poorly controlled with levodopa, will they have success with deep brain stimulation?
Symptoms will unlikely improve and may worsen
What is the effect of nutrition on Parkinson’s?
High protein diet can block levodopa absorption. Should reduce calories from protein by 15%
