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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
Stages of Hoehn and Yahr Scale
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
Unified PD Rating Scale
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
Medical Management of PD
1. Cabidopa Levodopa 2. Deep Brain Stimulation
28
Carbidopa-levodopa
-most effective drug for treating PD -carbidopa is decarboxylase inhibitor that prevents that breakdown of levodopa to dopamine in PNS
29
Adverse Effects of Carbidopa-Levodopa
GI disturbances orthostatic hypotension psychiatric problems
30
Wearing off of levodopa
decreased effectiveness of therapies at the end of the period doses
31
Levodopa-induced dyskinesias
excessive movement due to abnormal response to dopamine in the system
32
Deep Brain Stimulation
-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
Multiple System Atrophy
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
Multiple system atrophy w/predominant parkinsonism (MSA-P)
striatoniagral degeneration
35
Multople System Atrophy with cerebellar features
olviopontocerebellar atrophy
36
Progressive supranuclear palsy
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
Dementia with Lewy Bodies
presence of intraneuronal alpha synuclein but throughout the neocortex as opposed to in the substantia nigra presents with prominent psychiatric symptoms, dementia, hallucinations
38
Freezing of Gait Questionnaire
6 item questionnaire that assesses the severity of freezing unrelated to falls in people with PD
39
Parkinson's Fatigue Scale
helps to meausre the presence of fatigue and its impact on daily function
40
PDQ-39
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
Exercise Benefits in PD
-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
Rigidity Exercise
trunk rotation reciprocal movements rhythmic movements erect alignmnet large COM movements increase limits of stability
43
Rigidity impact on mobility
agonist/antagonist co-cont flexed trunk reduced trunk rotation reduced joint ROM high axial tone
44
Bradykinesia impact on mobility
slow small movements narrow bOS lack of arm swing
45
Bradykinesia and Exercise
fast large steps COM control large arm swings
46
Freezing and Mobility
-poor anticipatory postural stability -abnormal mapping of body and movement -abnormal visual-spatial maps -divided attention affects mobility
47
Freezing and Exercise
-improve weight shifting -understand role of external cues -exercise in small spaces -practice dual tasks
48
Inflexible Program Selection and Mobility
-poor rolling, STS, turns -difficult floor transfers -inability to change strategy quickly
49
Inflexible Program Selection and Exercise
-plan task in advance -quick change strategies -sequencing components of task
50
Impaired sensory integration and mobility
-inaccurate w/out vision -imbalance on unstable surface -poor alignment with environment
51
Impaired sensory integration and exercise
-kinesthetic awareness -decrease surface dependence -flexible orientation
52
Reduced executive function and attention and mobility
difficulty with dual tasks and sequences of action
53
Reduced executive function and attention and exercise
practice gait and balance with secondary task and sequences of actions

7 Neuro Dysfunction (7 decks)

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