Parkinson's Disease

Question 1

What clinical syndromes does PD apply to? TRAP

Answer 1

tremor +
Akinesia/bradykinesia +
rigidity +
postural instability

Question 2

PD is secondary to what 4 possible reasons?

Answer 2

traumatic
vascular (multiple strokes especially in BG)
endocrine
hydrocephaly

Question 3

Men or women more affected?

Answer 3

men

Question 4

What is average age of onset?

Answer 4

60s

Question 5

Why does PD result?

Answer 5

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

Question 6

What is BG?

Answer 6

a collection of gray matter that turns

Question 7

What are the 4 main parts of BG?

Answer 7

Striatum
Global Pallidus
Subthalmic
Substantia nigra

Question 8

What is BG 4 main functions?

Answer 8

turn movement on and off
eye movement
executive functions
mood

Question 9

What is the Direct Pathway of BG?

Answer 9

motor cortex excites striatum> turns movement on

since: DED= DOPAMINE is EXCITORY in Direct

Question 10

What is the Indirect Pathway in BG?

Answer 10

decrease in movement the Thalamus shuts off movement

DII: Dopamine is Inhibitory in Indirect

Question 11

How is Dopamine/Bg pathways and PD all related?

Answer 11

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.

Question 12

What S&S results from the different pathways?

Answer 12

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

Question 13

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

Answer 13

Limbic

Question 14

Dopamine+ direct pathway=

Answer 14

facilitating movement

Question 15

Dopamine+indirect pathway=

Answer 15

suppressing unwanted movements

Question 16

PD is ____ of dopamine?

Answer 16

loss

Question 17

What are some secondary motor signs in PD?

Answer 17

decrease ROM
Cardiovascaular decondition
pain
dystonia due to prolonged med use

Question 18

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

Answer 18

tremors

Question 19

When does tremors occur in PD?

Answer 19

rest
anxiety
with contralateral movements

Question 20

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

Answer 20

pill rolling not a resting tremor

Question 21

When is rigidity present not present in PD pt?

Answer 21

increase to slow passive movement

not present in voluntary movements

Question 22

What character of PD is most disabling?

Answer 22

bradykinesia

Question 23

What is brady and hypo -kinesia?

Answer 23

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

Question 24

What is Akinesia?

Answer 24

difficulty initiating movement

Question 25

Why is postural issues present in PD?

Answer 25

impaired postural reflexes needed to recover during a fall

Question 26

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

Answer 26

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

Question 27

How is gait in PD?

Answer 27

low velocity high cadence varied stride length episodes of freezing

Question 28

How is motor control in PD?

Answer 28

poor multitask poor motor planning poor dual task

Question 29

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

Answer 29

chronic constipation

Question 30

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

Answer 30

Levodopa

Question 31

What are two ways to quantify PD?

Answer 31

modified Hoehn & Yahr | Unified PD rating Scale ( gold standard)

Question 32

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

Answer 32

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

Question 33

Until what H&Y scale can they live independently?

Answer 33

Stage 3

Question 34

What stage of H&Y will you start PT?

Answer 34

Stage 3

Question 35

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

Answer 35

Tremor dominant 70% | PIGD (postural instability gait disorder) 30%

Question 36

What is Tremor dominant PD?

Answer 36

greater resting tremor & tremor with activity - progression is slower - better ADLs - better prognosis

Question 37

What is PIGD?

Answer 37

faster disease progression - worse ADLs - more cognitive impairments

Question 38

What is PD Plus?

Answer 38

worse prognosis - UMN (spastic) - Cerebellar signs (dysmetria, ataxia) - NO TREMOR - poor response to Levodopa - early cognitive signs - severe autonomic dysfunciton

Question 39

Levodopa therapy and dyskinesia, relationship?

Answer 39

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

Question 40

What is a surgical management of PD?

Answer 40

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

Question 41

PT and exercise does what to improve PD?

Answer 41

increase release of BDNF to increase signals and help increase neuroplasticity