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Lecture 6: Movement Disorders Flashcards

1
Q

These are classified as conditions that produce inadequate or excessive movement

A

Movement disorders

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2
Q

This is termed as Paucity, Slowness, Or Too Little Movement

A

Hypokinetic

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3
Q

This is termed as Excessive, Involuntary, or Too Much Movement

A

Hyperkinetic

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4
Q

This is termed as Abnormal movement

A

Dyskinesia

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5
Q

Parkinson’s disease and Atypical Parkinsonian Syndromes are classified as what type of movement disorders?

A

HypoKinetic

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6
Q

Essential Tremors, Huntington’s disease, And Dystonia are classified as what type of movement disorders?

A

Hyperkinetic

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7
Q

Movement disorders impair the regulation of voluntary activity without directly affecting what 3 things?

A
  1. Strengths
  2. Sensation
  3. Cerebellar Function
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8
Q

Movement disorders usually involve what structure in the brain?

A

The Basal Ganglia

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9
Q

Inputs to the motor system

Descending systems from the cortex are classified as?

A

Upper Motor Neurons

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10
Q

Inputs to the motor system

The motor cortex is responsible for what 3 tasks?

A
  1. Planning
  2. Initiating
  3. Directing Voluntary Movements
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11
Q

Inputs to the motor system

The brainstem centers are responsible for what 2 things?

A
  1. Basic Movements

2. Postural control

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12
Q

Inputs to the motor system

What is the responsibility of the Basal Ganglia?

A

Gating proper initiation of movement

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13
Q

Inputs to the motor system

What is the responsibility of the Cerebellum?

A

Sensory motor coordination of ongoing movement

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14
Q

Inputs to the motor system

The Basal Ganglia and the Cerebellum directly affect what aspects of the descending systems (UMN)?

A

Motor cortex and Brainstem Centers

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15
Q

Inputs to the motor system

The Local Circuit neurons (LMN) receives information from what 3 regions?

A
  1. Motor Cortex (UMN)
  2. Brainstem Centers (UMN)
  3. Sensory Input (LMN)
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16
Q

Inputs to the motor system

The spinal cord and brainstem circuits consist of? (2)

A
  1. Local Circuit Neurons (LMN Integration)

2. Motor Neuron Pools (LMN)

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17
Q

Inputs to the motor system

Sensory inputs send information to what region of the body?

A

Local Circuit neurons (LMN Integration)

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18
Q

Motor Neuron pools directly affect what aspect of the body?

A

Skeletal Muscle

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19
Q

This is a collection of Grey Matter Nuclei located deep within the white matter of the cerebral hemispheres

A

Basal Ganglia

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20
Q

What are the main components of the Basal Ganglia? (5)

A
  1. Caudate Nucleus
  2. Putamen
  3. Globes Pallidus
  4. Subthalamic Nucleus
  5. Substantial Nigra
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21
Q

What 3 regions of the Basal Ganglia make up the Striatum?

A
  1. Caudate Nucleus
  2. Putamen
  3. Globus Pallidus
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22
Q

What 2 parts of the Basal Ganglia make up the Lenticular Nucleus?

A
  1. Putamen

2. Globus Pallidus

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23
Q

The Basal Ganglia has what 2 types of Pathways?

A
  1. Direct

2. Indirect

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24
Q

Movement disorders associated with the Basal Ganglia are often explained by an (Blank) in the direct and indirect pathways.

A

Imbalance

-between the direct and indirect pathways in the basal ganglia

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25
Q

What are the Functional Attributes of the Basal Ganglia? (4)

A
  1. Entire Cerebral Cortex Provides input to the BG
  2. There is no direct sensory input to the BG
  3. BG does not reject directly to UMN/LMN
  4. BG lesions produce
    - Motor, behavior, and/or cognitive impairments
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26
Q

Basal Ganglia Lesions produce what 3 impairments?

A
  1. Motor Impairments
  2. Behavior Impairments
  3. Cognitive Impairments
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27
Q

Lesions of the Basal Ganglia motor circuits either produce? (2)

A
  1. Poverty of movement/Hypokinesia

2. Unwanted movement/Hyperkinesias

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28
Q

What are the 3 types of Hypokinesia?

A
  1. Akinesia
  2. Bradykinesia
  3. Rigidity
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29
Q

What are the different types of Hyperkinesias? (6)

A
  1. Resting Tremors
  2. Chorea
  3. Athetosis
  4. Tics
  5. Hemiballism
  6. Diatonic
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30
Q

Define: slowness of movement

A

Bradykinesia

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31
Q

Define: Loss or absence of movement

A

Akinesia

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32
Q

Define: Stiffness of muscle tone with passive movements

A

Rigidity

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33
Q

What are the 3 common signs seen in a patient with Parkinson’s Disease?

A
  1. Bradykinesia
  2. Akinesia
  3. Rigidity
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34
Q

What are the 4 main symptoms of Hyperkinesia movement Disorders?

A
  1. Tremors
  2. Chorea
  3. Dystonia
  4. Myoclonus
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35
Q

Define: Oscillatory, usually rhythmical and regular movement affecting one or more body parts

A

Tremor

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36
Q

Define: Random, quick, unsustained, purposeless movements that have an unpredictable, flowing pattern

A

Chorea

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37
Q

Tremors can be seen in what 2 disorders?

A
  1. Parkinson’s disease

2. Essential Tremors

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38
Q

Chorea can be seen in what 2 disorders?

A
  1. Huntington’s disease

2. Cerebral Palsy

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39
Q

Define: Torsional movements that are partially sustained and produce twisting postures

A

Dystonia

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40
Q

Define: Sudden, Brief, shock-like, involuntary movements usually caused by muscular contraction

A

Myoclonus

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41
Q

What is the prevalence of Parkinson Disease?

Cases per year?

A

160 cases per 100,000 people
6-7 million worldwide cases
1-2 million in US

At age 70, Increases to 550 cases per 100,000 people

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42
Q

What is the incidence of Parkinson’s Disease

Male to Female Ratio?

Mean age of symptoms onset?

A

Male 2:1 Female

Mean age of symptom onset is 56 in both sexes

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43
Q

With Parkinson’s disease, What is the etiology?

A
  1. Most cases are sporadic-Unknown cause
    - Idopathic PD
  2. Genetic Contributions 5-40% of cases
  3. Environmental Contributions
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44
Q

What is the phrase for Parkinson’s disease etiology?

A

“Genes load the gun”

“The Environment pulls the trigger”

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45
Q

Parkinson’s Disease is the degeneration of (Blank) neurons within the (Blank) and the (blank) in the brainstem

A
  1. Dopamine-Producing Neurons
  2. Substantial Nigra Pars Compacta
  3. Locus Ceruleus
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46
Q

Where does Parkinson’s disease effect the brain? (2)

A

Substantial Nigra Pars Compacta

Locus Ceruleus in the brainstem

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47
Q

With Parkinson’s Disease, there is an accumulation of mis-folded protein alpha-synuclien that spreads through brain areas forming _______________

A

Lewy BOdies

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48
Q

With Parkinson’s Disease, when symptoms become clinically evident, there is a 60% decrease in …

A

Dopaminergic Neurons of the Substantia Nigra

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49
Q

With Parkinson’s disease, dopamine levels have decreased by ____%

A

80% Decrease in Dopamine

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50
Q

What is the typical age of onset for Parkinson’s Disease?

Young Onset?

Late Onset?

A

Typical Onset: 55-60 years

Young Onset: < 40 years

Late Onset: >78 years

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51
Q

Describe the timeline of Parkinson’s Disease

A
  1. Death of Dopamine Cells
  2. Non motor symptoms (Loss of smell, constipation) and motor symptoms
  3. Dx
  4. Progression of all symptoms leading to probs with mobility
  5. Bed Bound: Dementia
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52
Q

These two created the stages for Parkinson’s Disease and there stage progression is called?

A

Hoehn and Yahr Stages

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53
Q

How long does it generally take to progression from one stage of Parkinson’s to the next?

A

Several Years

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54
Q

Hoeing and Yahr Stages of Parkinson’s Disease

Stage 1?

A

Stage 1: Symptoms 1 side of body

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55
Q

Hoeing and Yahr Stages of Parkinson’s Disease

Stage 2?

A

Stage 2: Bilateral/Axial

-No Balance Impairments

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56
Q

Hoeing and Yahr Stages of Parkinson’s Disease

Stage 3?

A

Stage 3: Balance Impairments

-Physically Independent

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57
Q

Hoeing and Yahr Stages of Parkinson’s Disease

Stage 4?

A

Stage 4: Severe Disability

-Able to stand or walk

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58
Q

Hoeing and Yahr Stages of Parkinson’s Disease

Stage 5?

A

Stage 5: W/C Bound or bed ridden

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59
Q

In order to be diagnosed with Parkinson’s Disease, what 2 things must be present?

A
  1. Bradykinesia and/or Resting Tremors
  2. 1 other disorder related to Parkinson’s
    - Non motor Symptoms
    - Freezing
    - Flexed Posture
    - Loss of postural reflexes
    - Rigidity
    - Bradykinesia
    - Resting Tremors
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60
Q

What are the 7 clinical findings related to Parkinson’s disease?

A
  1. Resting Tremors
  2. Bradykinesia
  3. Freezing
  4. Nonmotor Symptoms
  5. Flexed Posture
  6. Loss of Postural Reflexes
  7. Rigidity
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61
Q

What are the 6 Non-Motor Symptoms associated with Parkinson’s Disease?

A
  1. Fatigue
  2. Sensory awareness
  3. Sleep Disorders
  4. Neuro-psychiatric & Cognitive
  5. Autonomic Dysfunction
  6. Bradyphrenia
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62
Q

What are the other clinical findings associated with Parkinson’s disease.

Other Associated motor features? (5)

A
  1. Hypophonia (Soft Voice)
  2. Hypomimia (Masked Face
  3. Micrographia (Small Writing)
  4. Gait Abnormality (Shiffling, Freezing, En bloc turns (moving non-segmentally), Small Stride)
  5. Stooped, Flexed (Simian) Posture
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63
Q

How do resting tremors appear?

A

At rest, the tremor is occuring

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64
Q

How does Bradykinesia Present?

A

Tested with finger tapping test

Can someone close their index and thumb as quickly and big as possible

-The sped of the movement slows down and the size of the opening decreases

65
Q

What does a masked face look like?

A

The patient has no expression at all during any movement. Robot face if you will

66
Q

How does postural instability present with Parkinson’s Disease?

A

Patient is pulled backwards and the patient should be able to maintain balance.

-Parkinson’s patients will fall backwards with no reflexive step. Looks like a trust fall

67
Q

how does freezing and festinating gait present with Parkinson’s disease?

A

Very Short Steps

Shuffling and freezing are one in the same

Festering means quick little short steps

68
Q

What test is used to diagnose Parkinson’s disease?

69
Q

How does an MRI appear for a patient with Parkinson’s disease

70
Q

How is Parkinson’s Diagnosed?

A
    • Clinically based on History
    • Clinical Exam
    • absence of incompatible clinical
    • Laboratory
    • Radiologic abnormalities.
  2. Symptomatic Improvement with LEVADOPA helps to confirm Idiopathic PD
71
Q

Symptomatic Improvement with Levodopa helps to confirm what diagnosis?

A

Idopathic Parkinson’s Disease

72
Q

How can a PT clinically diagnose a patient with Parkinson’s Disease?

A
  1. Asymmetric Onset
  2. Gradual onset and progression
  3. Tremor is not required
  4. Two out of the following 6 symptoms
    - Resting Tremor, Bradykinesia, Freezing, Flexed Posture, Rigidity, Loss of postural responses
    * **At least one of these must be RESTING TREMOR or BRADYKINESIA
73
Q

What are the 3 types of Parkinsonism?

A
  1. Primary Idiopathic Parkinson’s Disease
  2. Secondary Parkinsonism
  3. Atypical Parkinsonism syndromes
74
Q

% of patients with…

  1. Primary Idiopathic Parkinson Disease
  2. Secondary Parkinsonism
  3. Atypical Parkinson’s Syndromes
A
  1. 80%
  2. 10-12%
  3. 3-5%
75
Q

With secondary Parkinsonism, what are the 7 causes?

A
  1. Drug Induced (7-9%)
  2. Vascular (1%)
  3. Hydrochephalus (NPH)
  4. Trauma
  5. Metabolic
  6. Tremors
  7. Toxins
76
Q

With Atypical Parkinsonian Syndromes, what are the causes?

A
  1. MSA
  2. PSA
  3. Dementia with Lewy BOdies
  4. CBD
77
Q

How is Parkinson’s Disease Prevented? (5)

A
  1. Diet
  2. Exercise
  3. Environmental Agents
  4. Neuro protection
  5. early Detection and Treatment
78
Q

With Parkinson’s Disease, how is it treatment medically? (4)

A
  1. Restore Dopamine producing cells
  2. Restore Dopamine
  3. Exercise
  4. Drugs
79
Q

For Symptomatic Parkinson’s Disease, what is this treated? (5)

A
  1. Drugs
  2. Deep Brain Stimulation
  3. Rehab Therapies
  4. Exercise
  5. Treat Symptoms
80
Q

What is the Gold Standard for Treating Parkinson’s Disease?

81
Q

This drug converts Dopamine once it enters the brain

82
Q

Dopamine alone does not cross what?

A

The blood brain barrier

83
Q

What is the prognosis or Parkinson’s Disease? (5)

A
  1. Lifespan is a few years less than normal
  2. Disease progression can be for 20 years or more
  3. Currently, there is no cure
  4. Usually slowly progressive, but with individual variability
  5. death from other causes such as Heart Disease, Cancer, Secondary Complications like Pneumonia
84
Q

What is the typical progression of Mild Parkinson’s Disease (5-7 Years post DX)? (4)

A
  1. Movement symptoms inconvenient, but do not affect daily activities
  2. changes in posture, walking ability or facial expression
  3. Parkinson’s Medication Effective
  4. Regular Exercise is important
85
Q

What is the typical progression of Moderate Parkinson’s Disease (7-15 years post DX)? (5)

A
  1. Motor Fluctuations and Dyskinesias
  2. Freezing Episodes occasional
  3. Regular exercise and skilled physical therapy very important for good mobility and balance
  4. Goal to keep them moving as often and safely as possible
  5. Gait and Balance duel task difficulty
86
Q

What is the Typical Progression of Advanced Parkinson’s Disease (15-20 years post DX)? (6)

A
  1. Cognitive problems may be prominent
    - Balance and Gait dual task difficulty
  2. Medication Less Effective
  3. May have frequent Freezing or Falls
  4. Swallowing - Dysphagia
  5. Autonomic dysfunction
    - Severe Orthostatic Hypotension
    - Severe Constipation causing impaction
  6. Weight loss
87
Q

For PT’s what is the clinical management of a patient with Parkinson’s disease? (6)

A
  1. Meaningful exercises the encourage power, extensor strengthening, body awareness, timing, coordination, and agility
  2. Dual task training
  3. Functional training with repetition, progression, and variability
  4. Vigorous aerobic exercise
  5. Skill-Specific practice
  6. Stress Reduction
88
Q

For Clinical management of the patient with Parkinson’s Disease, what are the key things we need to identify in these patients?

A
  1. Posture
  2. Gait Difficulties (Shuffling, Freezing, Turns)
  3. Balance
  4. Functional Mobility
  5. Dexterity
  6. Brady Kinesia
  7. Tremors
  8. Fatigue
  9. Difficulty Dual tasking
  10. Pain
89
Q

This can be known as Parkinson Plus Syndrome

A

Atypical Parkinsonian Syndromes

90
Q

What are the 3 major syndromes for Atypical Parkinsonian Syndromes/

A
  1. Progressive Supranuclear Palsy (PSP)
  2. Multiple System Atrophy (MSA)
  3. Corticobasal Degeneration (CBD)
91
Q

What is the Prevelence of Progressive Supranuclear Palsy (PSP)?

A

More frequent in men

Mean age onset 65 years of age

92
Q

What is the most frequent Atypical Parkinsonian Syndrome?

A

Progressive Supranuclear Palsy

93
Q

This form of Parkinson’s is marked by neuronal degeneration and neurofibrillary tangle and Tau-positive astrocytes in the basal ganglia and brainstem structures

A

Progressive Suprannuclear Palsy

94
Q

This form of Parkinson’s has a poor response to levodopa and dopamine agonists

A

Progressive supranuclear palsy

95
Q

What happens in Progressive Supranuclear palsy to their striatal neurons and their post synaptic dopamine receptors?

A

Loss of Striatal Neurons

Loss of Post Synaptic Dopamine Receptors

96
Q

What is the disease course for Progressive Supranuclear Palsy?

A

Insideous

Progressive

More rapid than PD

97
Q

What is the lifespan associated with progressive supranuclear palsy?

A

Death in 5-10 years often due to aspiration

98
Q

Describe the disease course for Progressive Supranuclear palsy

A
  1. Parkinsonian Symptoms, cognitive involvement, early falls, Axial rigidity, and absence of tremors
  2. Freezing, Supranuclear Gaze Palsy, Wide based Gait, Affected Speech, Facial Dystonia
  3. Progressive dementia, Dysphagia, Dysarthria, Emotional lability, volatile mood
  4. Progressive motor and cognitive decline until death
99
Q

What are the key clinical findings for Progressive Supranuclear Palsy (PSP)? (6)

A
  1. Progressive Parkinsonism
  2. Vertical Supranuclear ocular palsy or slow vertical Saccades
  3. Early onset of Falling
  4. Axial Rigidity
  5. Usually no Tremors
100
Q

Thesepatients eventually develop symptoms of both Parkinson’s disease, Autonomic Dysfunction, and Cerebellar Signs

A

Multiple Systems Atrophy (MSA)

101
Q

What is Multiple systems Atrophy

A
  1. Parkinsons disease
  2. Autonomic Dysfunction
  3. Cerebellar Signs
102
Q

With Multiple system atrophy, there is marked Neuronal degeneration of what? (3)

A
  1. Striatonigral pathways
  2. Olivopontocerebellar pathways
  3. Corticospinal pathways
103
Q

Multiple system atrophy, unlike Parkinson’s is more ________

A

Progressive

104
Q

At what stage are patients with Multiple Systems Atrophy (MSA) wheelchair bound?

105
Q

What is the mean survival rate of patients with Multiple systems Atrophy (MSA)

106
Q

Describe the disease course for Multiple System Atrophy

A
  1. Parkinsonian symptoms, Cognitive involvement, Autonomic dysfunction, cerebellar Ataxia
  2. Postural Instability, UMN signs, Bowel and Bladder
  3. Progressive Dementia, Dysphagia, Dysarthria
  4. Progressive Motor and Cognitive Decline until death
107
Q

What are the key feature for Multipe System Atrophy? (4)

A
  1. Parkinsonism
  2. Symptomatic Orthostatic Hypotension
  3. cerebellar Ataxia
  4. Poor Therapeutic Response to Levadopa
108
Q

What are the additional Symptoms associated with Multiple System Atrophy? (5)

A
  1. Increased DTR
  2. Bowel/Bladder Dysfunction
  3. Dysphagia and Dysarthria
  4. Early Postural Instability
  5. May not have tremors
109
Q

This is diagnosed as Nerve cell loss and atrophy of multiple areas of the brain including cortex and basal ganglia.

A

Corticobasal Degeneration

110
Q

Corticobasal Degeneration leads to significant parietal atrophy and is
A. Symmetric
B. Asymmetric

A

B. Asymmetric

111
Q

When does Corticobulbar Degeneration typically occur?

112
Q

Corticobasal degeneration usually starts to affect how much of the body?

A

1 side, but eventually becomes symmetric

113
Q

Patient’s with Corticobulbar Degeneration progress over the course of 6 to 8 years, but death is generally caused by …

114
Q

What are the key features for Corticobulbar Degeneration? (3)

A
  1. Parkinsonism
  2. Unilateral arm rigidity and Dystonia
  3. Cortical Sensory Deficits
115
Q

What are the other possible symptoms of Corticobasal Degeneration aside from the key features?

A
  1. UMN Features (Hyperreflexia and + Babinski)
  2. Apraxia
  3. Dementia
  4. Rigidity
  5. Dysphagia
  6. Myoclonus
  7. Alien Limb Phenomenon
116
Q

With Atypical Parkinsonian Syndromes, patients are often initially diagnosed with Parkinson’s Disease, but clinical findings and the fast rate of progression are indicative of Atypical progression. And MRI and PET can be performed, but are not diagnostic. PT’s should look for neuropsychiatric cognitive involvement.

A

With Atypical Parkinsonian Syndromes, patients are often initially diagnosed with Parkinson’s Disease, but clinical findings and the fast rate of progression are indicative of Atypical progression. And MRI and PET can be performed, but are not diagnostic. PT’s should look for neuropsychiatric cognitive involvement.

117
Q

This is a rhythmical sinusoidal movement of body parts

A

Tremor Syndromes

118
Q

With tremors, what part of the body may be involved?

A

All parts.

119
Q

In order to diagnose tremor syndrome, what must be checked?

A

Distinction that is made between rest and action tremor

120
Q

What is the definition of the resting tremor?

A

Tremor in body part not activated or supported against gravity

121
Q

What is a postural tremor?

A

Tremor in body part being supported AGAINST GRAVITY

122
Q

This is a tremor during any voluntary contraction of muscle

A

Action Tremor

123
Q

This is a tremor in a body part during any voluntary movement

A

Kinetic Tremor

124
Q

This is a tremor in a body part during non goal-directed movement

A

Simple Kinetic Tremor

125
Q

This is a tremor where the tremor in the body part increases during pursuit of a goal

A

Intention Tremor

126
Q

What is the different between simple kinetic tremor and intention tremor

A

Simple kinetic tremor is non goal directed

Intention tremor is goal directed

127
Q

What is the most common adult-onset movement disorder?

A

Essential Tremor

128
Q

When can essential tremors occur?

A

Most common on early 20’s or later in adulthood.

129
Q

Who is more likely to have an essential tremor, males or females?

A

Both are likely

130
Q

What is the Pathogeneis of Essential tremors?

A

Neuro Degeneration of the Cerebellum

Abnormal GABA function

131
Q

What is the etiology of Essential Tremors?

A

Familial in 50-70% of patients with Autosomal dominant transmission

132
Q

Essential tremors are not necessarily a progressive neurodegenerative disease, but tremor may do what?

A

Spread to different parts of the body

133
Q

Essential tremors are what kind of tremors?

A

Action Tremors

134
Q

What are the 4 clinical findings for Essential tremors?

A
  1. Action tremor of arms, head, voice
  2. Family history of tremors
  3. Absence of Parkinsonism
  4. Transient improvement of tremor with alcohol ingestion
135
Q

How does one determine if a patient has essential tremors?

A
  1. Absence of rest tremor
  2. Symmetric onset of action tremor
  3. Absence of other neurological signs (PD and Cerebellum)
  4. 50% are alcohol responsive
136
Q

What are the 3 differential diagnosis of Essential Tremors?

A
  1. Parkinson Disease
  2. Medication related tremor
  3. Enhanced Physiological Tremor
137
Q

How are essential tremors medically managed?

A
  1. Primidone: Anticonvulsant
  2. Propranolol: non-selective beta blocker used in treatment of hypertension
  3. Botox
  4. Surgical treatment: DBS in the thalamus
138
Q

What clinical management can be given for patients with essential tremors?

A

Adaptive equipment

-Tremor canceling spoons, pens weighted or larger utensils

139
Q

PD is an extensive disease with both significant ________ and __________ involvement

A

Motor and Nonmotor

140
Q

For the dx of PD, a person must have at least?

A

Tremors and/or Bradykinesia, and 1 other factor related to PD.

141
Q

This is the most common adult-onset movement disorder

A

Essential Tremors

142
Q

Essential tremors are what kind of tremors?

A

Action tremors

143
Q

What is the key difference between Essential tremors and PD tremors?

A

Essential tremors do not occur at rest like PD tremors

144
Q

What is the etiology of PD?

A

Unknown

-Genetic and Environmental factors

145
Q

What is the etiology of Atypical Parkinsonian Syndromes (PSP, MSA, and CBD)

  • PSP: Progressive Supranuclear Palsy
  • MSA: Multiple System atrophy
  • CBD: Corticobasal Ganglionic Degeneration
146
Q

What is the etiology of Essential Tremors

A

50-70% inherited

-Sporadic

147
Q

What are the signs and symptoms associated with PD? (4 key)

A
  1. Bradykinesia
  2. Rigidity
  3. Resting Tremor
  4. Postural Instability
148
Q

What are the signs and symptoms associated with Atypical Parkinsonian Syndrome?

  • PSP: Progressive Supranuclear Palsy
  • MSA: Multiple Systems Atrophy
  • CBD: Corticobasal Ganglionic Degeneration

(4)

A
  1. Early Falls
  2. Gaze Abnormalities
  3. Autonomic Dysfunction
  4. Early Dementia
149
Q

What are the signs and symptoms associated with Essential Tremors? (4)

A
  1. Action Tremors
  2. UE> Head
  3. Voice > LE
  4. Absence of other neurological signs related to PD
150
Q

How is PD Diagnosed?

A

Clinically

  1. Motor Signs/Symptoms
  2. Asymmetric Onset
  3. Gradual
  4. Responsive to Levadopa
151
Q

What is the Diagnosis for Atypical PArkinsinan Syndromes?

PSP: Progressive Supranuclear Palsy
MSA: Multiple Systems Atrophy
CBD: Cotricobasilar Ganglionic Degeneration

(2)

A

Clinical

  1. Non-Responsiveness to Levadopa
  2. Possible findings in MRI Imaging
152
Q

What are the diagnoses for Essential Tremors?

A

Clinical

  1. > 50% alcoholic Responsiveness
  2. Large Tremulous writing
  3. Bilateral Symmetric Onset
153
Q

What is the typical progression of PD?

A

Gradual Progression 20+ years

154
Q

What is the typical progression of Atypical Parkinsonian Syndromes

PSP: Progression Supranuclear Palsy
MSA: Multiple Systems Atrophy
CBD: Corticobasaliar Ganglionic Degeneration

A

More Rapid Progression

155
Q

What is the typical progression of Essential Tremors?

A

Stable or mildly progressive to other body areas

156
Q

How is PD Treated? (3)

A
  1. Medication (Levadopa)
  2. DBS (Deep Brain Stimulation
  3. Exercise!
157
Q

How is Atypical Parkinsoniann Syndrome typically treated?

PSP: Progresive Supranuclear Palsy
MSA: Multiple Systems atrophy
CBD: Corticobasilar Ganglionic Degeneration

A

Medication less effective

Symptomatic

Exercise

158
Q

How are Esential Tremors Treated?

A
  1. Medication (Proponolol, Primidone)

2. DBS (Deep Brain Stimulation)

Neuropathology (7 decks)

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