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)
