Parkinson's Flashcards
Parkinson’s Facts
Progress degenerative disease (slow decline). Patients have difficulty making automatic movements
Mean age of onset: early to mid 60s
more common in men > women (3:2)
What is the mean age of onset of PD
early to mid 60s
prevalence 1/100 in >60y/o
Risk of young onset of PD
5-10%
Is PD more common in men or women
more common in men (3:2)
Risk factors of PD
multifactorial - interplay between many factors
Age (increases exponentially until 80 y/o)
Gender
Pesticide exposure
Prior head injuries/concussion
Family history
Lewy bodies form in Substantia Nigra: could be causative or protective
Pathophysiology of PD
Problem to the basal ganglia where movements are refined
Impacts the inhibition and excitation of movements which causes deficits in coordination and smoothness of movements
Can have difficulty initiating movement and increasing movement through direct and indirect pathway
Pathophysiology of PD in direct pathway
Difficulty initiating movement
Not enough excitation/planning to initiate movement
Not increasing signals enough to initiate movement
Pathophysiology of PD in indirect pathway
difficulty increasing movement
difficulty inhibiting unwanted movements like tremor
Early symptoms of PD
Vague and non-specific
inexplicable tiredness
unwarranted fatigability
mild muscular aches and cramps
cognitive impairment affecting executive function and memory
depression
bradykinesia (slowness of movement), rigidity, tremor
Progressed symptoms of PD
Tremor resulting in spills of food/drink
Speech difficulties
reduced facial expression
possible drooling
difficulty initiating movement
freezing on social outings
postural instability, falls, freezing, dysphagia (difficulty swallowing)
Timeframe of PD symptoms
symptoms may appear up to 20 years before diagnosis and may extend to 20 years after diagnosis
increasing severity of symptoms and disability over time
Starts with mild non-motor symptoms, progresses to motor symptoms and ultimately leads to severe disability in the advanced stages due to motor and non-motor complications
Symptoms of PD before diagnosis
constipation, depression, fatigue
Primary impairments of PD (motor, non-motor)
Motor
- bradykinesia
- hypokinesia
- akinesia
- decreased postural stability
- tremor (resting/action)
- rigidity
Non-motor
- decreased autonomic function
- decreased sensory function
Secondary impairments of PD (motor, non-motor)
Motor
- Dyskinesia
- Dystonia
Non-motor
- neuropsychiatric features
- sleep problems
- pain
- fatigue
What is bradykinesia
slowness of movements
What is hypokinesia
Small amplitude of movements
What is akinesia
Difficulty initiating/maintaining movement
Absence of movement
What is freezing
Difficulty starting or continuing movements - speech, handwriting, gait
Freezing of gait - episodic gait disturbance
Typically see festination prior to freezing: progressive shortening of stride length and increasing cadence
What is a resting tremor for PD
involuntary, rhythmic movement of a body part (4-6Hz): typically hands, feet, lips, chin affected
small frequency, small range
suppressed by voluntary activity - sleep and complete relaxation
What can rigidity be increased by
stress/anxiety
Why do the secondary motor impairments (dyskinesia, dystonia) occur in PD
occur after taking dopamine replacement medication for an extended period
What is dyskinesia
involuntary movement
- can occur in head or trunk
What is dystonia
often in the plantarflexors or wrist flexors
Continuous or repetitive muscle twisting/spasm
What is the difference between tremor and dyskinesia
Tremor is a primary impairment, caused by the loss of dopamine in the BG from PD. It is typically the first sign of PD, with regular direction and amplitude. At rest 4-6Hz.
Dyskinesia is a secondary impairment indirectly caused by PD medication, so takes a while to develop. Irregular in direction and amplitude (1-4Hz)
What is the difference between PD and conditions similar to PD (Atypical Parkinsonism or Parkinson-plus syndromes) Supranuclear palsy, multiple system atrophy, corticobasal degeneration
These conditions don’t respond to dopaminergic treatments and have a worse prognosis than PD
What scale is used for PD disease severity
Hoehn and Yahr Scale
Stage 1 and 2 (Mild) - Early PD
Stage 3 (moderate) - mid stage PD
Stage 4 and 5 (severe) - advanced PD
What is current management like for PD
No cure for PD
Current therapies aim to treat the symptoms of the disease
Management is multidisciplinary - medical and non-medical
Physio management of PD focuses on…
Balance and motor function/skill
What is the most successful way to treat PD symptoms
Drug management
What does levadopa do for PD
Levadopa is a dopamine replacement agent for the treatment of PD. This helps to control bradykinetic symptoms
Problems: after 5-10 years it starts to wear off, dyskinesia, depression, nausea
What do dopamine agonists do for PD
Mimics dopamine in the brain
Can be given alone or with L-dopa
side effects: nausea and postural hypotension
What do monoamine oxidase type B inhibitors do
cause dopamine to accumulate in surviving nerve cells and reduce the symptoms of PD
side effects: confusion or delirium
What do Catechol-O-methyltransferase (COMT) inhibitors do?
Prologue L-dopa’s effects by preventing the breakdown of dopamine
side effects: urine discolouration, diarrhoea, abdominal pain
What do anticholinergics do?
effective for tremor
side effects: memory impairment, confusion and psychosis, dry mouth
What does amantadine do
Reduce symptoms and dyskinesia. It is often used alone in PD early stages
What drug is effective for tremor in PD
Anticholinergics
What drug is used in early stage PD
Amantadine
When would you use surgical management (targeted gene therapy, stem cell transplantation, deep brain stimulation) for PD
when patients can’t deal with the side effects of the drugs
What are the different surgical management options for PD
Targeted gene therapy
Stem cell transplantation
Deep brain stimulation
What is deep brain stimulation
like a pacemaker for motor control
most common surgical treatment in PD
Eases symptoms/reduce medication needs
Used for motor problems
Physiotherapy management of PD
main goal of physio management is to prolong activities, independence, balance and ability to walk for as long as possible
Cueing and attentional cognitive strategies to help initiate movements and maintain movements and reduce bradykinesia and hypokinesia. E.g. taping, metronome
Task specific training - part and whole task
Falls prevention: balance training, home modifications, multifactorial interventions, prescription of aids and equipment
General exercise: treadmill, training, dance, martial arts
- helps delay progression of neurological diseases. Neuroprotective effects
main goal of physiotherapy management in PD
main goal of physio management is to prolong activities, independence, balance and ability to walk for as long as possible
Why is cueing and attentional strategies important for PD patients
help to initiate and maintain movements
reduce or avoid freezing from happening
What a PD falls prevention treatment plan would look like (Morris et al)
Progressive resistance strength training or movement strategy training (mobility, balance during functional tasks) + education focused on falls risk and prevention + cueing strategies if freezing occurred
PD-WEBB program
LSVT-BIG for PD
focuses on amplitude of movement rather than speed
aims to restore normal movement amplitude by recalibrating a patients sensory perception of movement
Discuss role of other health practitioners in management of patients with PD
OT: assist with ADL’s
Speech therapist: help with communication and swallowing issues
Neurologists: manage medication
Dietician: nutritional needs
Social workers: social aspects
Psychologists: mental health
