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7 Neuro Dysfunction > L3 Parkinson's > Flashcards

L3 Parkinson's Flashcards

1
Q

Pathophysiology of PD

A

-Complex progressive neurodegenerative disease with idiopathic onset
-defined by loss of dopaminergic neurons in substantia nigra pars compact located in midbrain and associated with lewy bodies
-presents as unilateral and then becomes bilateral
-progresses insidiously over 5-15 years

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2
Q

When do symptoms of PD typically emerge?

A

after a loss of 50-70% of SNpc dopaminergic neurons

loss of dopaminergic in basal ganglia precedes onset of motor symptoms

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3
Q

Lewy bodies

A

intraneuronal protein aggregates, deposits of a protein called alpha-synuclein

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4
Q

Prevalence/incidence of PD

A

onset is at 40-70 yo
affects 1% of individuals over 65
higher in males vs femlaes

happens more in the rust belt (s CA, s. TX, PN, FL)

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5
Q

Clinical Diagnosis/Presentation of PD

A

-Motor Features
-Non-Motor Features
-Late stage non-motor features

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6
Q

Motor Features of PD

A

Tremors
Bradykinesia
Rigidity
Hypomimia
Hypophonia
Micrographia
Postural stability
Retropulsion
Freezing
Festinating Gait
En bloc turning

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7
Q

Non Motor Features of PD

A

depression
anxiety
REM sleep behavior disorder
Bradyphrenia
Cognitive Decline

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8
Q

Resting Tremor

A

-most commonly observed when the limb is relaxed
-asymmetrical and involves mainly the hands and UE, may involve LE and chin
-pill-rolling, looks like like they are rolling their a pill between their fingers

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9
Q

Postural Tremor

A

-subtype of action tremor
-occurs with holding position against gravity

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10
Q

Bradykinesia and Hypokinesia

A

slowed and decreased amount of movements

can be caused by increased inhibitory basal ganglia outflow to the thalamus

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11
Q

Rigidity

A

an increase in resistance to passive movement of a limb

cogweel is seen in PD, which is characterized by ratchet-like interruptions in tone felt as you move the limb passively through ROM. Rigidity with superimposed tremor

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12
Q

Masked faces/hypomimia

A

decrease in spontaneous blink rate and facial expression

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13
Q

Hypophonia

A

reduced vocal loudness

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14
Q

Micrographia

A

writing becomes smaller

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15
Q

Postural Instability

A

decreased ability to make reflex postural adjustments to maintain balance

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16
Q

Retropulsion

A

if pulled back slightly, may require several steps to regain balance

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17
Q

Freezing

A

difficulty initiating movement

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18
Q

Festinating gait

A

small shuffling steps

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19
Q

En bloc turning

A

turning with the trunk as one unit instead of with twisting at the torso

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20
Q

REM sleep behavior

A

slep disorder in which a person physically enacts out their dreams

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21
Q

Bradyphrenia

A

responses are slowed, appropriate if given enough time

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22
Q

Cognitive Decline

A

dementia is not an early feature of PD, but estimated to present later in the course of 15-40% of cases

commonly see executive dysfunction

23
Q

Prognostic Factors for PD

A
  1. Those with severe baseline continue to be more impaired later in disease process
  2. Presentation w/out tremor may be predictor of more rapidly increasing disability
  3. Older age may be predictor of more rapidly increasing disability
  4. Cognitive impairment is increased with future disability and motor impairment
24
Q

Hoehn and Yahr Scale

A

measures severity of PD’s symtpoms, classifies patients in following stages

stage 1-5

25
Q

Stages of Hoehn and Yahr Scale

A

1 = unilateral involvement
1.5 = unilateral and axial involvement
2 = bilateral s/s, no balance impairment
2.5 = mild bilateral disease with recovery on pull test
3 = mild to mod disease physically independent
4 = severe disability, still able to walk or stand assisted
5 = w/c or bedridden

26
Q

Unified PD Rating Scale

A

50 Q assessment to rate the motor and non-motor symptoms associated with PD

Part 1 = non-motor experiences of daily living
2 = motor experiences of daily living
3 = motor exam
4 = motor complications

27
Q

Medical Management of PD

A
  1. Cabidopa Levodopa
  2. Deep Brain Stimulation
28
Q

Carbidopa-levodopa

A

-most effective drug for treating PD
-carbidopa is decarboxylase inhibitor that prevents that breakdown of levodopa to dopamine in PNS

29
Q

Adverse Effects of Carbidopa-Levodopa

A

GI disturbances
orthostatic hypotension
psychiatric problems

30
Q

Wearing off of levodopa

A

decreased effectiveness of therapies at the end of the period doses

31
Q

Levodopa-induced dyskinesias

A

excessive movement due to abnormal response to dopamine in the system

32
Q

Deep Brain Stimulation

A

-stimulus delivered by implanted stimulation device that can be externally programmed and turned off at any time
-tx is bilateral
-targets subthalamic nucleus in pts with advanced PD

33
Q

Multiple System Atrophy

A

more prominent autonomic dysfunction and loss of striatal neurons projecting to the GP and SNpr

associated with atrophy of intermediolateral cell column of SC and makes dopaminergic therapies ineffective

MSA-P and MSA-C are variants

34
Q

Multiple system atrophy w/predominant parkinsonism (MSA-P)

A

striatoniagral degeneration

35
Q

Multople System Atrophy with cerebellar features

A

olviopontocerebellar atrophy

36
Q

Progressive supranuclear palsy

A

most common atypical parkinsonism syndrome, about 5% of patients

degeneration of structures in midbrain-deincephalic junction

presents as early postural instability, dementia, dysarthria, dysphagia, supranuclear gaze palsy

37
Q

Dementia with Lewy Bodies

A

presence of intraneuronal alpha synuclein but throughout the neocortex as opposed to in the substantia nigra

presents with prominent psychiatric symptoms, dementia, hallucinations

38
Q

Freezing of Gait Questionnaire

A

6 item questionnaire that assesses the severity of freezing unrelated to falls in people with PD

39
Q

Parkinson’s Fatigue Scale

A

helps to meausre the presence of fatigue and its impact on daily function

40
Q

PDQ-39

A

QOL measure looking at how often they have experienced a variety of emotions or challenges in the last month scoring from never to always on a 5 point scale

41
Q

Exercise Benefits in PD

A

-neurogenesis, an increase in dopamine synthesis and release, increased dopamine in striatum
-preservation of dopaminergic cell bodies and terminals associated with improved running distance and speed
-aerobic programs improves gait parameters, WOL, levodopa efficacy

42
Q

Rigidity Exercise

A

trunk rotation
reciprocal movements
rhythmic movements
erect alignmnet
large COM movements
increase limits of stability

43
Q

Rigidity impact on mobility

A

agonist/antagonist co-cont
flexed trunk
reduced trunk rotation
reduced joint ROM
high axial tone

44
Q

Bradykinesia impact on mobility

A

slow small movements
narrow bOS
lack of arm swing

45
Q

Bradykinesia and Exercise

A

fast large steps
COM control
large arm swings

46
Q

Freezing and Mobility

A

-poor anticipatory postural stability
-abnormal mapping of body and movement
-abnormal visual-spatial maps
-divided attention affects mobility

47
Q

Freezing and Exercise

A

-improve weight shifting
-understand role of external cues
-exercise in small spaces
-practice dual tasks

48
Q

Inflexible Program Selection and Mobility

A

-poor rolling, STS, turns
-difficult floor transfers
-inability to change strategy quickly

49
Q

Inflexible Program Selection and Exercise

A

-plan task in advance
-quick change strategies
-sequencing components of task

50
Q

Impaired sensory integration and mobility

A

-inaccurate w/out vision
-imbalance on unstable surface
-poor alignment with environment

51
Q

Impaired sensory integration and exercise

A

-kinesthetic awareness
-decrease surface dependence
-flexible orientation

52
Q

Reduced executive function and attention and mobility

A

difficulty with dual tasks and sequences of action

53
Q

Reduced executive function and attention and exercise

A

practice gait and balance with secondary task and sequences of actions

7 Neuro Dysfunction (7 decks)

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