Parkinson II Flashcards
Hoehn-Yahr Classification of Disability Scale
determines progression of the disease- motor signs and functional status
stage I- minimal disease involvement
stage 5- severe involvement with patient confined to bed or w/c
most widely used in clinical trials and research
Unified Parkinson’s Disease Rating Scale
gold standard for measuring progression
4 parts:
I- mentation, behavior, mood
II- ADLs
III- Motor examination
IV- complications
30 to 45 mins, free, and was revised
5 times sit to stand test
timed measure
helps determine fallers from no fallers
16s is the cut off time
> 16s than likely a faller
used for more than just Parkinson’s patients
Parkinson’s Disease Questionnaire (PDQ-39)
subjective report of the impact of PD
8 heath related quality of life dimensions
score 0-100
PD medications
Levodopa/ Carbidopa
Dopamine agonists
Anticholinergics
Monoamine oxidase B inhibitors
Levodopa/ Carbidopa
sinemet- gold standard drug for PD therapy
precursor that is metabolized to dopamine in the brain
most l-dopa metabolized (almost 99%) before reaching brain, requiring high doses
L-dopa given with carbidopa help more l-dopa into the brain before being metabolized
only effective 4 to 6 years for optimal benefit
“wear off” patients will have “on” and “off” periods
several SE if not dosed properly
primary benefits are motor symptoms-bradykinesia and rigidity
Dopamine agonists
act like dopamine to stimulate post synaptic receptors
generally best for those with declining effectiveness of L-dopa/carbi
common names- requip and mirapex
can have SE similar to L-dopa/carbidopa
Anticholinergics
block cholinergic function
generally used early in PD
adjunct to -dopa/carbi
not effective alone
SE- dizziness, blurred vision, dry mouth, urinary retention
Monoamine oxidase B inhibitors
monoamine oxidase B-enzyme that degrades dopamine
can have a modest effect in slowing progression of PD
used with =dopa/carbi, helps to keep dosages low
few adverse effects
Deep brain stimulation
implantation of electrodes into the brain- block nerve signals that cause symptoms
placement- subthalamic nucleus and occasionally globus pallidus
very promising for treatment of advanced PD
DBS has been shown to successfully control PD symptoms of motor overactivity (dyskinesias), , substantially increase “on” time, and improve ADL scores.
LSVT/BIG
4 weeks, 4x week, 1 hour per visit
technique- large amplitude, multiple repetitions, whole body, increase in complexity
Pt interventions
external cues:
- generation of movement in response to external stimuli is processed premotor cotex
- signal then bypasses basal ganglia
rhythmic auditory stimulation:
-interactive metronome
visual cues:
- laser light or stripes on the floor
- cane
