Parkinson's Disease Flashcards
As it related to motor control specifically, the basal ganglia utilize indirect and direct pathways to ____ and ____movement. They also prevent unwanted movement via _____.
initiate and execute
inhibition
4 additional role of the BG (not including motor control) are
eye-movement loop (spatial attn/saccades)
goal-directed behavior
social behavior loop
emotion loop
Primary NTs of the BG system are:
dopamine (movement facilitator)
Ach
GABA/Glutamate
T/F: The primary neurotransmitter for the direct/indirect motor pathways is dopamine.
false. they are glutamate/ GABA
Describe general demographics related to PD incidence. and prevalence.
most onsets >/= 60y/o
men>women
decreased prevalence in Black/Asian pop
Etiology unknown, PD is considered to be an interaction of these factors (3)
age, genetics, and environment
Pathophysiology of PD involves the depletion of ___in the BG and loss of ____ in the substantia nigra.
dopaminergic neurons
DA stores
PD is definitively diagnosed via ____ but can also be suggested via SPECT scan/ DaTscan, levodopa/carbiopa trials, and ___
post mortem examination; clinical exam (via exclusion)
Cardinal motor s/s of PD include: brady/hypo/akinesia, rigidity, tremor, and ____ (3)
postural instability, weakness, and breakdown of complex motor planning
Addressing postural instability should always be a priority for our PD pts as its a huge RF for falls along with ____ (2)
disease severity
gait impairments (esp freezing)
T/f: Weakness in PD only comes from delayed MU recruitment.
false. it’s multifaceted and can also be due to decrease torque production , asyncronization. disuse and fatigue.
What is the difference between continuous and episodic gait changes we may observe in PD?
continuous: overall hypokinesis, poor variability and posture, asymmetry
episodic: freezing, festinating, midline disorientation, en bloc turns
____/____is often an early symptom expressed by a majority (60-80%) of PD pts. It’s attributed to abnormal ___related to dopamine levels.
pain/paresthesia; modulation
Common areas of hyperparesthesia and pain are:
low back, legs, shoulders and face
between postural instability phenotype and tremor-dominant phenotype, which is more prevalent? Which has the lowest morbidity (motor, non-motor and cog) ?
most prevalent/lowest mobility: tremor-dom
These 3 drug classes are typically used in conjunction with levodopa/carbidopa, the first line defense.
dopamine agonists, COMT inhibitors and anticholinergics
T/F: COMT inhibitors are typically used to manage tremors in early stage PD.
false: it’s anticholinergics.
Levodopa/DBS does NOT help with:
improving axial rigidity
external perturbation rxn strategies
later stage hypokinetic gait
“on” state freezing
Why might someone choose to try deep brain stimulation (DBS)?
motor s/s no longer responding to meds;
increased on periods and reduced frequency of off times
With the exception of _____, life expectancy for PD pts is often slightly less than avg.
PD dementia (Lewy Body Dementia)
The 2 most prevalent fatal sequelae are
CHF
pneumonia
Negative prognostic indicators of PD include smoking, symmetry of s/s, young onset, and (4)
male gender
phenotype (postural instability worse)
Poor/early decline in cog
higher UPDRS
The PDQ-39 assess QOL over the last ____ in the domains of mobility, ADLs, bodily discomfort, cog, and ____
month; emotional wellbeing, stigma, social support and communication
The MDS-UPDRS assessesburden and extent of PD for what duration?
the entire course of the disease
