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Neuro 2 > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

general S&S of BG dysfunction

A

difficulty initiating, continuing or stopping movement
muscle tone abnormalities
increased involuntary movements

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2
Q

what is parkinson’s disease

A

idiopathic, slowly progressive degenerative disease

degeneration of dopaminergic neurons in teh BG - loss of DA stores in substantia nigra

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3
Q

incidence and prevalence of PD

A

> 60 yrs
men > women

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4
Q

what causes primary parkinsonism

A

complex interaction
age, genetics, envrionment

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5
Q

what causes secondary parkinsonism

A

infectious/postencephalitic, atherosclerosis, toxic, drug induced

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6
Q

what is the only definite way to diagnosis PD

A

post-mortem examination of the brain

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7
Q

what are the cardinal motor symptoms seen

A

bradykinesia
hypokinesia
akinesia
rigidity
tremor
postural instability
weakness
breakdown of complex motor planning

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8
Q

when do motor symptoms occur

A

when roughly 60% of neurodegeneration has already occurred in the BG

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9
Q

what does rigidity look like in this population

A

asymmetrical early on then progresses to whole body involvement even including trunk

proximal first

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10
Q

what do tremors look like in this population

A

resting tremor early on
mild, low frequency

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11
Q

what body part’s typically have tremors

A

hand and foot most common but can see head, neck, jaw or tongue

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12
Q

patients with PD are 9x more likely to do what

A

fall - increasingly prevalent in middle stages, disappear in late stages as pt’s become immobile

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13
Q

what are the 3 biggest overall risk factors for falls in PD pt’s

A

postural instability
disease severeity
gait impairments (freezing)

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14
Q

what are some other risk factors for falls

A

dementia, depression, postural hypotension, involuntary movements from long term med use

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15
Q

what would an EMG result look like for these pt’s

A

delayed MU recruitment, asynchronization

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16
Q

what does continuous gait look like

A

overall hypokinetic presentation

slower, smaller steps, decreased arm swing, minimal trunk rotation

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17
Q

as disease progresses, what type of gait do they demonstrate

A

festinating gait

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18
Q

episodic early and middle stages of PD - what are three gait characteristics seen

A

festinating gait
midline disorientation
en bloc turning
freezing of gait

19
Q

what is en bloc turning

A

compensatory movement
decreased rotation of head, trunk, pelvis
turning as one whole unit

20
Q

what can en bloc turning be impacted by

A

increased postural tone, axial rigidity and/or loss of flexibility

impaired motor control, bradykinesia, freezing

21
Q

what are some non-motor symptoms seen with PD

A

pain - likely MSK related
loss of smell
sleep issues
visual impairments
OH
fatigue
etc.

22
Q

what areas of the body are pt’s typically feeling pain

A

lower back
legs
shoulders
face

23
Q

what are 2 PD subgroups

A

postural instability gait disorder phenotype
tremor dominant phenotype

24
Q

postural instability gait disorder phenotype is like what

A

20% of all cases
postural instability and gait issues
more significant disease course

25
Q

tremor dominant phenotype

A
  • fewer problems with bradykinesia or postural instability
  • lower prevalence of non-motor symptoms
  • less likely to develop dementia and other cog
26
Q

what is the Hoehn and Yahr scale

A

PD staging scale
relates to impairment and functional mobility, includes unilateral/bilateral involvement

27
Q

what is stage 1 on the Hoehn and Yahr scale

A

unilateral involvment only

28
Q

what is stage 1.5 on the Hoehn and Yahr scale

A

unilateral and axial involement

29
Q

what is stage 2 on the Hoehn and Yahr scale

A

bilateral involvement without impairment of balance

30
Q

what is stage 2.5 on the Hoehn and Yahr scale

A

mild bilateral disease with recovery on pull test

31
Q

what is stage 3 on the Hoehn and Yahr scale

A

mild to moderate bilateral disease
some postural instability
physically independent

32
Q

what is stage 4 on the Hoehn and Yahr scale

A

severe disability
still able to walk or stand unassisted

33
Q

what is stage 5 on the Hoehn and Yahr scale

A

wheelchair bound or bedridden unless aided

34
Q

what can prolonged use of medication lead to

A

dyskinesias

35
Q

what does levodopa not improve

A

axial rigidity
worsens postural responses to external perturbations
less effective at improving gait as the disease progresses
does not improve freezing of gait during the “ON” state

36
Q

what is deep brain stimulation used for

A

bradykinesia, rigidity and tremor in pt’s who no longer respond to meds or who suffer from medication-induced dyskinesias

37
Q

what are some negative prognostic indicators

A

degree of symmetry
postural instability gait disorder
higher baseline UPDRS motor scores
younger age at onset
early cog decline
smoking hx
male gender

38
Q

what is the PDQ-39

A

evaluates PD specific health related quality of life over last month

closely correlates with H&Y

39
Q

what is MDS-UPDRS

A

comprehensive assessment desgined to monitor the burden and extend of PD across the longitudinal disease course - 4 parts

40
Q

what are the 4 parts of the MDS-UPDRS

A
  1. non motor experiences of daily living**
  2. motor experiences of daily living
  3. motor exam**
  4. motor complications
41
Q

whats the cut off score for MoCA

A

greater than or equal to 26 pts considered normal

42
Q

what is the parkinsons fatigue scale

A

reflects physical aspects of fatigue
measures presence of fatigue and impact on daily fxn

43
Q

what is the freezing of gait questionnaire

A

assess FOG severity unrelated to falls in pt’s with PD
correlates well with H&Y stage

Neuro 2 (37 decks)

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