Parkinson I

Question 1

Parkinson definition

Answer 1

progressive disorder of the CNS with both motor and nonmotor symptoms

Question 2

PD incidence

Answer 2

affects 1 million Americans

7 to 9 million worldwide

~2% over 65 have PD

Alzheimers only other neuro degenerative disorder more common

average age of onset is 50-60 yo

Question 3

Parkinsonism

Answer 3

generic term used to describe disorders of the basal ganglia (BG)

Question 4

PD clinical subgroups

Answer 4

1. Postural instability gait disturbed(PIGD)-poor balance and changes in gait
2. Tremor predominant-tremor usually primary characteristic. Few problems with bradykinesia or postural instability.

Question 5

Secondary Parkinsonism-

4 types

Answer 5

1. Postencephaic parkinsonism
2. Toxic parkinsonism
3. Drug-induced parkinsonism
4. Metabolic conditions

Question 6

Postencephalic parkinsonism

Answer 6

result of influenza outbreak in 1917-1926

this type no longer seen. most individuals have passed.

Question 7

Toxic parkinsonism

Answer 7

symptoms occur in individuals exposed to certain environmental toxins, including pesticides and industrial chemicals

occurs secondary to long term exposure to toxins

maganese is the primary culprit

Question 8

Drug-induced parkinsonism

Answer 8

variety of drugs can produce exrapyramidial dysfunction that mimics the signs of PD

interfere with dopaminergic mechanisms either presynap or postsynap

once medication is removed symptoms generally reverse

medications responsible- neuroleptic drugs, antidepressant drugs, antihypertensive drugs

Question 9

Metabolic conditions

Answer 9

result in calcification of the basal ganglia

hypothyroidism, hyperparathyroidism, hypoparathyroidism, and Wilson’s disease (too much copper in brain and liver)

Question 10

Parkinson’s plus syndrome

Answer 10

group of neurodegenerative diseases that produce symptoms of PD and affect the substantia nigra

Diseases: Shy-drager syndrome (slowness of movement, rigidity, poor balance. Now called multiple system atrophy)

Progressive supranuclear palsy (rare brain disorder that affects control of gait and balance)

Multi infarct vascular disease

Alzheimers

CTE

Creutzfeldt Jakob (fatal brain disorder-mad cow disease)

Question 11

PD Pathophysiology

Answer 11

degeneration of dopamine producing neurons in the substantia nigra of the basal ganglia

disruption occurs in the dopamine-acetylcholine balance in the basal ganglia

symptoms don’t occur until 30-60% of the substantia nigra cells have been lost

Cortex talks to the basal ganglia and the BG and thalamus coordinate the motion

PD defined by (1) degeneration of dopaminergic neurons in the BG in the pars compactus of the substantia nigra that produces dopamine and (2) as the disease progresses and neurons degenerate, the presence of Lewy bodies.

Question 12

Primary motor symptoms

Answer 12

1. Rigidity
2. Bradykinesia
3. Tremor
4. Postural instability

Question 13

Rigidity

Answer 13

increased resistance to passive motion

one of clinical hallmarks of PD

2 types

Often asymmetrical, especially the early stages of PD

Affects the proximal muscles first

Results in decreased ROM and increasing energy expenditure and fatigue levels

Question 14

Cog-wheel rigidity

Answer 14

jerking, ratcher like resistance to passive motion as the muscles alternate between contraction and relaxation

Question 15

Lead pipe rigidity

Answer 15

a sustained resistance to passive movement, no change in resistance

Question 16

Bradykinesia

Answer 16

slowness of movement

insufficient muscle recruitment during initiation

internally signals are scaled down prior to being sent to activate muscles

akinesia- poverty of spontaneous movement

Freezing-occurs with a change of stimuli. Generaly short lived.

hypokinesia-slowed or reduced movements can also be seen in PD

Question 17

Tremor

Answer 17

involuntary shaking or oscillatory motions of a portion or segment of the body

caused by alternating contractions and relaxation of agonist and antagonist muscles

postural tremor- tremor of head or neck

resting tremor-present a rest but disappears with action (most common type in PD)

action tremor- occurs at rest and continues with movement. appears later stages of PD.

Question 18

Postural instability

Answer 18

result of abnormalities of posture and balance

poor postural responses

inflexible responses

difficult controlling COM

attentional demands greatly impact postural stability

rare in the early years (ex 5 after diagnosis)

leads to greater fall risk

Question 19

Secondary motor symptoms

Answer 19

1. muscle function
2. muscle performance
3. GAIT

Question 20

SMS-Muscle function

Answer 20

strength reduced-could be dopamine related (better with “on” period)

torque reduced at all speeds

motor units-recruitment reduced and delayed (“under recruitment”)

fatigue- one of most common symptoms reported. Difficulty sustaining any activity. Individual muscles fatigue quickly as well. -dopa therapy can help with fatigue.

Question 21

SMS-Gait

Answer 21

Up to 1/3 of PD patients present with gait disturbance as their initial motor symptom

reduction in arm swing and asymmetry

Festinating Gait-progressive increase in speed and shortening of stride length. Cause by an abnormal stooped posture.

Other gait characteristics- narrow BOS, forward posture, flexed knees

Question 22

SMS-motor function

Answer 22

motor planning deficits evident in PD

loss of regulatory control in autonomic and involuntary movement

movement preparation is prolonged

start-hesitation especially evident as disease progresses

Question 23

Non-motor symptoms

Answer 23

1. Sensory symptoms
2. Dysphagia
3. Speech disorders
4. Sleep disorders
5. Cognitive dysfunction

Question 24

NMS-Sensory symptoms

Answer 24

primary sensory loss does not occur

up to 50% of patients report parethesias (burning, tingling, numbness, pain, or pricking sensation). Could be from the disease’s effect on central nociception.

Postural stress syndrome- results from poor postures and strain on ligaments, muscles, and joints. Causes pain. Ex. back pain may accompany a prolonged, stooped, kyphotic posture.

Proprioceptive regulation of voluntary movement may also be impaired. Difficulty in perceiving the extent of movement.

Olfactory dysfunction is common- decline or loss in sense of smell (anosmia).

Question 25

NMS- Dysphagia

Answer 25

impaired swallowing due to rigidity, reduced mobility, and restricted ROM

presents in 95% of PD patients

considered an early symptom of disease

complications- nutritional deficiency and aspiration pneumonia

probems with tounge control, delayed swallow response, and chewing. Can cause choking and weight loss.

Sialorrhea (drooling)- increased saliva production and inability to manage secretions due to dysphagia

Question 26

NMS-Speech disorders

Answer 26

hypokinetic dysarthria- decreased voice volume, monotone, imprecise speech ad altered articulation/pronouncement

Huge social impact- one of the reasons patients stay at home

Question 27

NMS- Cognitive dysfunction

Answer 27

mild (mild impaired memory) to severe (dementia)

Bradyphrenia- slowed thinking.processing. One of the first signs of PD, however often missed.

Dementia with PD is very common

The lower cognitive function the higher mortality risk

Behavioral changes

Question 28

NMS-Sleep disorders

Answer 28

insomnia common- falling asleep and staying asleep[

daytime somnolence common (sleepiness)

active sleeping- enacting dreams and intense vivid dreaming.