Parkinson 1 Flashcards

1
Q

• Idiopathic PD

• Parkinson’s plus
– Multiple system atrophy (aka Shy-Drager syndrome)
– Progressive supranuclear palsy
– Lewy body disease

• Parkinsonism
– Postencephalitic,
– Drug-induced, toxin-induced
– Vascular

A

• Idiopathic PD

• Parkinson’s plus
– Multiple system atrophy (aka Shy-Drager syndrome)
– Progressive supranuclear palsy
– Lewy body disease

• Parkinsonism
– Postencephalitic,
– Drug-induced, toxin-induced
– Vascular

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2
Q

Parkinson’s disease, paralysis agitans, shaking palsy

• Idiopathic,  
• Degenerative 
• CNS disorder  
• with 4 characteristic features 
1. \_\_\_\_\_\_\_\_\_\_\_\_
2. \_\_\_\_\_\_\_\_\_\_\_\_
3. \_\_\_\_\_\_\_\_
4. \_\_\_\_\_\_\_
A

Parkinson’s disease, paralysis agitans, shaking palsy

• Idiopathic,  
• Degenerative 
• CNS disorder  
• with 4 characteristic features 
1. Slowness & poverty of movement 
2. Muscular rigidity 
3. Resting tremor 
4. Postural instability 

• POSTURAL INSTABILITY :
late feature
• Must exclude drug-induced disease
• Definitive diagnosis on autopsy

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3
Q

Based on clinical signs, physical examination, history
• 2 of the 3 cardinal signs must be present
– Tremor : resting tremor (disappears with movement), increases with stress
– Rigidity : “ratchet”-like stiffness (cogwheel rigidity); also leadpipe rigidity
– Akinesia /bradykinesia : subjective sense of weakness, loss of dexterity, difficulty using kitchen tools, loss of facial expression, reduced blinking, difficulty getting out of bed/chair, difficulty turning while walking.

A

Based on clinical signs, physical examination, history
• 2 of the 3 cardinal signs must be present
– Tremor : resting tremor (disappears with movement), increases with stress
– Rigidity : “ratchet”-like stiffness (cogwheel rigidity); also leadpipe rigidity
– Akinesia /bradykinesia : subjective sense of weakness, loss of dexterity, difficulty using kitchen tools, loss of facial expression, reduced blinking, difficulty getting out of bed/chair, difficulty turning while walking.

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4
Q

Diagnosis
• Non-motor symptoms at presentation
______________________

A
Diagnosis 
• Non-motor symptoms at presentation 
– Pain 
– Urinary frequency 
– Anxiety, depression 
– Constipation 
– Hyposmia (olfactory dysfunction)
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5
Q

Clinical presentation of PD

A
Micrgraphia
Hypomimia
Hypophonia 
Hyperhidrosis
Decrease blink rate
Orthostatic hypotension 
Psychosis
Sleep disturbance 
Confusion
Dementia
Festination
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6
Q

Idiopathic PD – features at initial presentation

A
  • Asymmetric
  • Positive response to levodopa or apomorphine
  • Postural instability (& falls) - not present
  • Less rapid progression (rapid = H&Y 3 in 3 years)
  • Autonomic dysfunction – not present
  • Neuroimaging - ??
  • Impaired olfaction (?)
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7
Q

Morbidity

A
  • Unable to perform ADLs
  • Choking
  • Pneumonia
  • Falls
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8
Q

Pathology

A

• Loss of dopaminergic neurons in the substantia nigra
– About 80% loss –> clinical symptoms

• Age-related loss of neurons?
• Environmental toxin / insults?
– MPTP-MPP+
– Pesticides, herbicides

• Genetics?
– Predisposition to toxins / insults
– Genetic abnormalities

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9
Q

Stage One
– Signs and symptoms on one side only
– Symptoms mild
– Symptoms inconvenient but not disabling
– Usually presents with tremor of one limb
– Friends have noticed changes in posture, locomotion and facial expression

A

Stage One
– Signs and symptoms on one side only
– Symptoms mild
– Symptoms inconvenient but not disabling
– Usually presents with tremor of one limb
– Friends have noticed changes in posture, locomotion and facial expression

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10
Q

• Stage Two
– Symptoms are bilateral
– Minimal disability, able to walk
– Posture and gait affected

A

• Stage Two
– Symptoms are bilateral
– Minimal disability, able to walk
– Posture and gait affected

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11
Q

Stage Three
– Significant slowing of body movements
– Early impairment of equilibrium on walking or standing – Generalized dysfunction that is moderately severe

A

Stage Three
– Significant slowing of body movements
– Early impairment of equilibrium on walking or standing – Generalized dysfunction that is moderately severe

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12
Q
Stage four 
– Severe symptoms  
– Can still walk to a limited extent  
– Rigidity and bradykinesia  
– No longer able to live alone  
– Tremor may be less than earlier stages
A
Stage four 
– Severe symptoms  
– Can still walk to a limited extent  
– Rigidity and bradykinesia  
– No longer able to live alone  
– Tremor may be less than earlier stages
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13
Q
Stage Five  
– Cachectic stage  
– Invalidism complete  
– Cannot stand or walk  
– Requires constant nursing care
A
Stage Five  
– Cachectic stage  
– Invalidism complete  
– Cannot stand or walk  
– Requires constant nursing care
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14
Q

“Measuring” PD - Hoehn and Yahr
• Assesses mobility
• If on treatment, should be assessed when the person is in the “ON” and also in the “OFF” state

A

“Measuring” PD - Hoehn and Yahr
• Assesses mobility
• If on treatment, should be assessed when the person is in the “ON” and also in the “OFF” state

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15
Q

“Measuring” PD – Unified Parkinson’s Disease Rating Scale

(1) Mentation, Behaviour, Mood – E.g. intellectual impairment, depression
(2) Activities of Daily Living – E.g. speech, salivation, swallowing, dressing, hygiene, walking
(3) Motor Examination – E.g. facial expression, tremor at rest, gait
(4) Complications of Therapy – E.g. dyskinesias, clinical fluctuations

A

“Measuring” PD – Unified Parkinson’s Disease Rating Scale

(1) Mentation, Behaviour, Mood – E.g. intellectual impairment, depression
(2) Activities of Daily Living – E.g. speech, salivation, swallowing, dressing, hygiene, walking
(3) Motor Examination – E.g. facial expression, tremor at rest, gait
(4) Complications of Therapy – E.g. dyskinesias, clinical fluctuations

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16
Q

Early/young onset PD

  • ~40YO
    • Slower disease progression
    • Features
    – < cognitive decline
    – earlier motor complications
    – dystonia is common initial presentation vs falls & freezing in late-onset
    • Dopamine agonists used in preference to levodopa
A

Early/young onset PD

  • ~40YO
    • Slower disease progression
    • Features
    – < cognitive decline
    – earlier motor complications
    – dystonia is common initial presentation vs falls & freezing in late-onset
    • Dopamine agonists used in preference to levodopa
17
Q

Goal of treatment
X Replace dopamine
X Cure

✔Manage symptoms
✔Maintain function & autonomy

A

Goal of treatment
X Replace dopamine
X Cure

✔Manage symptoms
✔Maintain function & autonomy

18
Q

Treatment modalities

• Pharmacological 
– INCREASE central dopamine, dopaminergic transmission 
• Levodopa 
• Dopamine agonists 
• MAO B inhibitors 
• COMT inhibitors  

– Correct imbalance in other pathways
• Reduce cholinergic activity with anticholinergics
• NMDA antagonists

A

Treatment modalities

• Pharmacological 
– INCREASE central dopamine, dopaminergic transmission 
• Levodopa 
• Dopamine agonists 
• MAO B inhibitors 
• COMT inhibitors  

– Correct imbalance in other pathways
• Reduce cholinergic activity with anticholinergics
• NMDA antagonists

19
Q

Nonpharmacological

A

– Physiotherapy
• Stretching, transfers, posture, walking

– Occupational therapy
• Mobility aids, home & workplace safety

– Speech & swallowing
• Vocal exercises

– Surgery
• Deep brain stimulation (DBS)