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Maturity II Final > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What clinical syndromes does PD apply to? TRAP

A

tremor +
Akinesia/bradykinesia +
rigidity +
postural instability

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2
Q

PD is secondary to what 4 possible reasons?

A

traumatic
vascular (multiple strokes especially in BG)
endocrine
hydrocephaly

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3
Q

Men or women more affected?

A

men

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4
Q

What is average age of onset?

A

60s

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5
Q

Why does PD result?

A

due to loss of dopaminergic neurons in the Substantia Nigra in the BG

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6
Q

What is BG?

A

a collection of gray matter that turns

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7
Q

What are the 4 main parts of BG?

A

Striatum
Global Pallidus
Subthalmic
Substantia nigra

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8
Q

What is BG 4 main functions?

A

turn movement on and off
eye movement
executive functions
mood

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9
Q

What is the Direct Pathway of BG?

A

motor cortex excites striatum> turns movement on

since: DED= DOPAMINE is EXCITORY in Direct

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10
Q

What is the Indirect Pathway in BG?

A

decrease in movement the Thalamus shuts off movement

DII: Dopamine is Inhibitory in Indirect

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11
Q

How is Dopamine/Bg pathways and PD all related?

A

due to lack of Dopamine: direct BG pathway gets suppressed, and the indirect can’t be suppressed, therefore NET EFFECT is loss of movement in both pathways.

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12
Q

What S&S results from the different pathways?

A
  • involuntary saccades
  • issues with prefrontal lobe (executive fx, dual task, problem solving)
  • mood disorder, depression, sleep issue since BG communications with LIMBIC SYSTEM
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13
Q

What system is connected with BG that results in sleep and mood issues?

A

Limbic

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14
Q

Dopamine+ direct pathway=

A

facilitating movement

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15
Q

Dopamine+indirect pathway=

A

suppressing unwanted movements

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16
Q

PD is ____ of dopamine?

A

loss

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17
Q

What are some secondary motor signs in PD?

A

decrease ROM
Cardiovascaular decondition
pain
dystonia due to prolonged med use

18
Q

What is the 1st sign in PD for 80% of pt?

A

tremors

19
Q

When does tremors occur in PD?

A

rest
anxiety
with contralateral movements

20
Q

What is the classic tremor in PD called? is it a resting tremor?

A

pill rolling not a resting tremor

21
Q

When is rigidity present not present in PD pt?

A

increase to slow passive movement

not present in voluntary movements

22
Q

What character of PD is most disabling?

A

bradykinesia

23
Q

What is brady and hypo -kinesia?

A

bradyk: low speed and low amplitude
hypok: limited movement that starts normal and gets smaller

24
Q

What is Akinesia?

A

difficulty initiating movement

25
Q

Why is postural issues present in PD?

A

impaired postural reflexes needed to recover during a fall

26
Q

How is postural reflex tested in PD? whats a + response

A

pull test: response greater than 2 steps or lack of any response

27
Q

How is gait in PD?

A

low velocity
high cadence
varied stride length
episodes of freezing

28
Q

How is motor control in PD?

A

poor multitask
poor motor planning
poor dual task

29
Q

What S&S appears before motor S&S in PD?

A

chronic constipation

30
Q

If this drug helps S&S you may have PD.

A

Levodopa

31
Q

What are two ways to quantify PD?

A

modified Hoehn & Yahr

Unified PD rating Scale ( gold standard)

32
Q

What are the 0-5 grades for H&Y staging?

A

0: no signs of PD
1: unilateral disease
1. 5: unilateral + axial involvement
2: bilateral disease, with good balance
2. 5: mild bilateral, recovery present in pull test
3: mild to mod bilateral, some postural instability
4: Severe disability, still can walk or stand unassisted
5: W/C bound or bedridden

33
Q

Until what H&Y scale can they live independently?

A

Stage 3

34
Q

What stage of H&Y will you start PT?

A

Stage 3

35
Q

What are the 2 subtypes of PD? and their %?

A

Tremor dominant 70%

PIGD (postural instability gait disorder) 30%

36
Q

What is Tremor dominant PD?

A

greater resting tremor & tremor with activity

  • progression is slower
  • better ADLs
  • better prognosis
37
Q

What is PIGD?

A

faster disease progression

  • worse ADLs
  • more cognitive impairments
38
Q

What is PD Plus?

A

worse prognosis

  • UMN (spastic)
  • Cerebellar signs (dysmetria, ataxia)
  • NO TREMOR
  • poor response to Levodopa
  • early cognitive signs
  • severe autonomic dysfunciton
39
Q

Levodopa therapy and dyskinesia, relationship?

A

as PD progresses, there is a shorter winder of management of symptoms, bigger peaks and bigger valleys, therefore not effective with Levodopa

40
Q

What is a surgical management of PD?

A

DBS : deep brain stimulation: estim to BG to remove inhibition of thalamus and helps movement occur.

41
Q

PT and exercise does what to improve PD?

A

increase release of BDNF to increase signals and help increase neuroplasticity

Maturity II Final (12 decks)

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