Parkinson's

Question 1

What are the cardinal signs of PD?

Answer 1

tremor, rigidity, bradykinesia, postural instability

——- Other motor symptoms
- gait dysfunction
- difficulty with dual task performance
- dyskinesias

Question 2

(true/false) PD is no longer just a motor disorder

Answer 2

true

Question 3

What are the non-motor characteristics of PD?

Answer 3

• cognitive dysfunction/Hallucinations
• dementia
• depression
• pain
• fatigue
• sensory disturbance

Question 4

(true/false) PD is the slowest growing of all neurological disorders

Answer 4

FALSE (fastest)

Question 5

What populations have a higher prevalence of PD?

Answer 5

whites and hispanics

Question 6

What is the average age of PD onset?

Answer 6

60-65 y/o

Question 7

Young-onset PD is typically diagnosed between ages __-__

Answer 7

21-40

Question 8

What is the first sign of PD in 70% of patients?

Answer 8

tremor that occurs at rest and worsens with anxiety and contralateral motor activity

Question 9

How is PD-associated tremors differentiated from essential tremors?

Answer 9

• presents asymmetrically
• pill rolling
• predominant at rest

Question 10

What is the most characteristic feature of PD?

Answer 10

bradykinesia

Question 11

definition: a catching and releasing throughout the range of motion

Answer 11

cogwheel ridigity

Question 12

definition: refers to a slow and sustained contraction during range of motion

Answer 12

lead pipe rigidity

Question 13

When does bradykinesia increase?

Answer 13

With contralateral motor activity or mental task performance

Question 14

What is the hallmark of PD and is one of the earliest functional limitations identified by patients?

Answer 14

gait dysfunction

Question 15

Do abnormal involuntary movements occur during the on or off period of the medication cycle?

Answer 15

on period
–> involve the head, trunk, limbs, and sometimes the muscles of respiration

Question 16

definition: as PD progresses, a phenomenon called the “on-off” or “wearing off” phenomenon in which symptoms wax and wane

Answer 16

dyskinesias

Question 17

Are freezing episodes more severe in the on or off state of the medication cycle?

Answer 17

off state

Question 18

What autonomic disorders commonly occur with PD?

Answer 18

• urinary incontinence
• symptomatic postural hypotension

Question 19

Pain has been identified in as many as ___% of patients with PD.

Answer 19

80%

Question 20

What are the categories of PD?

Answer 20

• postural instability and gait disorder-predominant (PIGD)
• tremor predominant
• mixed

Question 21

The ____ subtype of PD has FASTER disease progression, greater occupational disability, more intellectual impairment, higher likelihood of depression, and lack of motivation. They score as more impaired than tremor-predominant patients on the Activities of Daily Living subscale of the Unified Parkinson’s Disease Rating Scale (UPDRS).

Answer 21

PGID

Question 22

Progression of symptoms typically is (slower/faster) for the tremor dominant subgroup

Answer 22

slower

Question 23

(true/false) In the majority of cases, the cause of PD cannot be identified

Answer 23

true

Question 24

The best understood environmental cause of PD is _______.

Answer 24

encephalitis

Question 25

Drug induced parkinsonism can also result from some ______ medications

Answer 25

neuroleptic

Question 26

Cigarette smoking may (decrease/increase) the risk of PD

Answer 26

decrease --> possibly because carbon monoxide is a free radical scavenger

Question 27

Confirmation of PD is only via ___.

Answer 27

autopsy

Question 28

What criteria should you follow for clinical diagnosis of PD?

Answer 28

1. clinically possible if the patient has a resting tremor, asymmetric rigidity, or asymmetric bradykinesia; 2. clinically probable if the patient has any 2 of the above symptoms; and 3. definite if, in addition, there is a definitive response to anti-parkinsonian drugs.

Question 29

PD has long been associated with loss of _______ cells in the substantia nigra of the midbrain.... however, the site of action of this neurotransmitter loss is in the basal ganglia

Answer 29

dopamine-producing

Question 30

Dopamine is normally transmitted by way of nigrostriatal neurons from the brainstem to the ____

Answer 30

basal ganglia

Question 31

Current theory of PD is that the progressive loss of nigrostriatal neurons is accompanied by an increase in ____ cells in the substantia nigra and a loss of ____.

Answer 31

increased glial cells; loss of neuromelanin

Question 32

What in non-motor areas may account for the non-motor symptoms associated with PD?

Answer 32

Lewy bodies of surviving nigrostriatal neurons

Question 33

(true/false) All pharmacological agents used to treat people with PD ***ARE NOT*** associated with significant side effects

Answer 33

FALSE (they are) gastrointestinal (eg, nausea, vomiting, constipation) CNS (eg, confusion, delirium, hallucinations, behavioral changes) neurologic (eg, dyskinesias, dystonias) cardiovascular (eg, orthostatic hypotension, dysrhythmias)

Question 34

Motor symptoms become too disabling if patient is in the (on/off) state for too long during the day

Answer 34

off state

Question 35

Current surgical methods rely on ______ of deep brain structures

Answer 35

e-stim

Question 36

The sites for deep brain stimulation (DBS) include the _____ or ____.

Answer 36

globus pallidus or subthalamic nuclei

Question 37

Modified H & Y scale stage ___: no signs of disease

Answer 37

0

Question 38

modified H & Y scale stage ___: unilateral disease

Answer 38

1

Question 39

Modified H & Y scale stage ___: unilateral plus axial involvement

Answer 39

1.5

Question 40

Modified H & Y scale stage ___: bilateral disease without impairment of balance

Answer 40

2

Question 41

Modified H & Y scale stage ___: mild bilateral disease; recovery on the pull test

Answer 41

2.5

Question 42

Modified H & Y scale stage ___: mild-moderate bilateral disease, some postural instability; physically independent

Answer 42

3

Question 43

Modified H & Y scale stage ___: severe disability but able to walk or stand unassisted

Answer 43

4

Question 44

Modified H & Y scale stage ___: WC bound or bedridden unless receiving aid from someone

Answer 44

5

Question 45

Those who undergo DBS can only improve to their best (on/off) state condition prior to the DBS

Answer 45

on state

Question 46

What surgical management intervention addresses the symptoms of the disease but does not affect the progression of the disease?

Answer 46

DBS (deep brain stimulation) --> therefore, those symptoms not addressed by the DBS will continue to worsen over time

Question 47

What are adverse effects of DBS?

Answer 47

- dysarthria (9.3%) - weight gain (8.4%) - miscellaneous motor (4.0%) - intracranial hemorrhage (3.9%) - psychiatric (3.5%) - stimulation-induced dyskinesia (2.6%)

Question 48

What H & Y stages of PD will benefit from physical intervention?

Answer 48

stages 1-3 --> however optimal frequency and intensity are not yet determined

Question 49

Original H & Y scale stage ___: unilateral involvement with no or minimal functional involvement

Answer 49

1

Question 50

Original H & Y scale stage ___: bilateral or midline involvement without impairment of balance

Answer 50

2

Question 51

Original H & Y scale stage ___: impaired righting reflexes with some restriction in functional activity, but with the capacity for living independently

Answer 51

3

Question 52

Original H & Y scale stage ___: severely incapacitating disease but ale to walk and stand independently

Answer 52

4

Question 53

Original H & Y scale stage ___: confined to bed and WC unless receiving assistance

Answer 53

5

Question 54

Compared to shorter format LSVT-BIG or general exercise, LSVT-BIG was (less/more) effective at improving motor function.

Answer 54

more effective

Question 55

(true/false) Most of the available studies on physical interventions have focused on people in early and mid stages of PD

Answer 55

true

Question 56

What are the parameters for LSVT BIG?

Answer 56

4 consecutive days x 60 minutes x 4 weeks

Question 57

(true/false) Tests that are predictive of falls in the general population have comparable sensitivity and specificity for people with PD

Answer 57

FALSE (they do not)

Question 58

What scale provides a quick and easy method to identify the general stage of PD

Answer 58

H & Y

Question 59

What scale is considered as the gold standard for quantifying signs and symptoms of PD?

Answer 59

Unified Parkinson’s Disease Rating Scale (UPDRS)

Question 60

What outcome measures are used for QOL in patients with PD?

Answer 60

PDQ-39 Parkinson’s Disease Quality of Life Questionnaire (PDQL)