Parkinson's Disease Flashcards
Idiopathic Parkinson’s Disease
- Chronic neurological disease
- The result of a loss of dopamine producing neurons in the pars compacta of substantia nigra (basal ganglia)
- Insidious onset, typically in 6th decade
** Does not present w/ neurological signs (UMN - spasticity, hyperreflexia)
Parkinsonism
A state of mimicking or appear to look like idiopathic PD w/o actually having PD
Ex. MS - can look like PD if it is affecting the basal ganglia
Parkinson’s-Plus Syndrome
Neurodegenerative disease that produce parkinsonism as well as other neurological signs (present like UMNL)
4 cardinal feactures of PD?
TRAP
T - Tremor (at rest)
R - Rigidity
A - Akinesia or Bradykinesia
P - Postural Instability
Must present with at least 2 cardinal signs and exclusion of alternate diagnosis or explanation for presenting signs
Temor (AT REST)
- Occurs at rest and disapears with voluntary mvmt
- commonly manifests in “pill-rolling” tremor of the hand (between finger & thumb)
- Resting tremor may also be seen in the forarm (pronation-supination), jaw, or tongue
- LE tremor is more apparent when in supine
Rigidity
- INC resistance to passive movement (independent from speed or posture - NOT velocity dependent)
- Rigidity is often asymmetrical, affects proximal to distal, may progress to entire body (trunk > LE)
- 2 Types:
1. Cogwheel - rachet type mvmt
2. Leadpipe - constant resistance throughout mvmt
Disease progression = INC rigidity = INC loss of function = INC contractures = INC resting energy expenditure
Trunk rigidity = INC difficulty performing bed mobility
Arm rigidity = DEC arm swing when walking
** Reflexes - NO changes in tendon reflexes b/c rigidity is not linked to changes in UMN
Akinesia / Bradykinesia
- Problems with voluntary movements - planning, initation, & execution of mvmt
Akinesia: absense of movement
- Freezing gait: moments where there is a sudden stop in movement with a temporary inability to move - “feet are glued to the floor”
Bradykinesia: slowness of movement
- Movements are often reduced in speed, range, and amplitude
Hypokinesia: decreased amplitude of movement
- Movements are not as BIG
Kinesia Paradoxa: pt w/ PD might automatically move quickly (normally) if there is an unexpected stimulus
- Ex. someone throws a ball at them & they catch it
What is the most disabling S/S of PD?
Bradykinesia
Postural Instability
- Abnormalities in posture and balance
- Develops later in the disease
- Patients have the inability to use normal postural synergues to recover balance d/t abnormal coactivation patterns leading to rigidity
- Patients will often adopt a STOOPED posture d/t INC weakness in trunk extensor mms
- Kyphosis & scoliosis d/t have more rigidity on one side of the trunk
What is the most common postural deformity in PD?
Kyphosis
Festinating Gait
Kyphosis > stooped posture - places CoG ahead of the patient (d/t leaning forward) & could be displaced outside LOS & constantly need to establish a new BOS
= Always trying to catch up to their LOS
Motor Planning
5 Key Aspects
- Start hesitation
Difficulty initating a movement - Freezing episodes
Temporary inability to move - can be triggered by competing stimulus (external environment -> something on the floor, narrow hallway, doorways, freeze in elevator when the door closes) &/ or exacerbated by stress - Hypomimia (masked face)
Reduction in facial expression and animation (may appear that they do not care - rather it is just part of the presentation - Poverity of movement
DEC in number and amplitude of movement - Micrographia
Abnormally small handwriting
Early S/S - early on in the disease
Gait
7 Characteristics
- Festinating Gait
Shorten strides with progressively increasing speed
Repeated stepping strategy
Anteropulsive (forward) or Retropulsive (backwards) -> stepping out of the way when someone comes towards them
Gets faster & faster -> breaks out almost to a run/trot -> may run into a wall or object due to difficulty stopping - Freezing Gait
Movements where there is a sudden stop in movement with a temporary inability to move
- Happens more often when there is more ATTENTION demands or complex environments - Shuffling steps
DEC hip, knee and anke flexion - LOW steps > not picking up thie feet enough - DEC trunk rotation
- DEC arm swing
- Both are d/t rigidity - Difficulty with dual task demands - ex walking or talking
- Difficulty with INC attentional demands - complex environemtns (obstacles)
Early S/S
(7)
- Loss of smell or taste
- masked face
- Dysphagia
- Dysphonia
- Problems w/ voice (in PD) = DEC speech volume - very low & quiet / limited in amount of info they give you - Micrographia
- Festinating gait
- Stooped posture (contriubtes to festinating gait)
Later S/S
- Difficulty arising from a chair
- Difficulty turning over in bed
- Cognitive changes/dementia
- Sialorrhea (drooling)
- GI dysfunction: constipation, decreased appetite
- Foot dystonia - uncontrolled & often painful mm contractions
- causes the foot to twist & turn INWARD
