Parkinson's Flashcards
general S&S of BG dysfunction
difficulty initiating, continuing or stopping movement
muscle tone abnormalities
increased involuntary movements
what is parkinson’s disease
idiopathic, slowly progressive degenerative disease
degeneration of dopaminergic neurons in teh BG - loss of DA stores in substantia nigra
incidence and prevalence of PD
> 60 yrs
men > women
what causes primary parkinsonism
complex interaction
age, genetics, envrionment
what causes secondary parkinsonism
infectious/postencephalitic, atherosclerosis, toxic, drug induced
what is the only definite way to diagnosis PD
post-mortem examination of the brain
what are the cardinal motor symptoms seen
bradykinesia
hypokinesia
akinesia
rigidity
tremor
postural instability
weakness
breakdown of complex motor planning
when do motor symptoms occur
when roughly 60% of neurodegeneration has already occurred in the BG
what does rigidity look like in this population
asymmetrical early on then progresses to whole body involvement even including trunk
proximal first
what do tremors look like in this population
resting tremor early on
mild, low frequency
what body part’s typically have tremors
hand and foot most common but can see head, neck, jaw or tongue
patients with PD are 9x more likely to do what
fall - increasingly prevalent in middle stages, disappear in late stages as pt’s become immobile
what are the 3 biggest overall risk factors for falls in PD pt’s
postural instability
disease severeity
gait impairments (freezing)
what are some other risk factors for falls
dementia, depression, postural hypotension, involuntary movements from long term med use
what would an EMG result look like for these pt’s
delayed MU recruitment, asynchronization
what does continuous gait look like
overall hypokinetic presentation
slower, smaller steps, decreased arm swing, minimal trunk rotation
as disease progresses, what type of gait do they demonstrate
festinating gait
episodic early and middle stages of PD - what are three gait characteristics seen
festinating gait
midline disorientation
en bloc turning
freezing of gait
what is en bloc turning
compensatory movement
decreased rotation of head, trunk, pelvis
turning as one whole unit
what can en bloc turning be impacted by
increased postural tone, axial rigidity and/or loss of flexibility
impaired motor control, bradykinesia, freezing
what are some non-motor symptoms seen with PD
pain - likely MSK related
loss of smell
sleep issues
visual impairments
OH
fatigue
etc.
what areas of the body are pt’s typically feeling pain
lower back
legs
shoulders
face
what are 2 PD subgroups
postural instability gait disorder phenotype
tremor dominant phenotype
postural instability gait disorder phenotype is like what
20% of all cases
postural instability and gait issues
more significant disease course
tremor dominant phenotype
- fewer problems with bradykinesia or postural instability
- lower prevalence of non-motor symptoms
- less likely to develop dementia and other cog
what is the Hoehn and Yahr scale
PD staging scale
relates to impairment and functional mobility, includes unilateral/bilateral involvement
what is stage 1 on the Hoehn and Yahr scale
unilateral involvment only
what is stage 1.5 on the Hoehn and Yahr scale
unilateral and axial involement
what is stage 2 on the Hoehn and Yahr scale
bilateral involvement without impairment of balance
what is stage 2.5 on the Hoehn and Yahr scale
mild bilateral disease with recovery on pull test
what is stage 3 on the Hoehn and Yahr scale
mild to moderate bilateral disease
some postural instability
physically independent
what is stage 4 on the Hoehn and Yahr scale
severe disability
still able to walk or stand unassisted
what is stage 5 on the Hoehn and Yahr scale
wheelchair bound or bedridden unless aided
what can prolonged use of medication lead to
dyskinesias
what does levodopa not improve
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
what is deep brain stimulation used for
bradykinesia, rigidity and tremor in pt’s who no longer respond to meds or who suffer from medication-induced dyskinesias
what are some negative prognostic indicators
degree of symmetry
postural instability gait disorder
higher baseline UPDRS motor scores
younger age at onset
early cog decline
smoking hx
male gender
what is the PDQ-39
evaluates PD specific health related quality of life over last month
closely correlates with H&Y
what is MDS-UPDRS
comprehensive assessment desgined to monitor the burden and extend of PD across the longitudinal disease course - 4 parts
what are the 4 parts of the MDS-UPDRS
- non motor experiences of daily living**
- motor experiences of daily living
- motor exam**
- motor complications
whats the cut off score for MoCA
greater than or equal to 26 pts considered normal
what is the parkinsons fatigue scale
reflects physical aspects of fatigue
measures presence of fatigue and impact on daily fxn
what is the freezing of gait questionnaire
assess FOG severity unrelated to falls in pt’s with PD
correlates well with H&Y stage
