Parkinson's Disease

Question 1

Parkinson’s

Answer 1

• movement disorder, but assoc w/ neuropsychiatric deficits as disease progresses.
• Earlier age=slower progression, but average age at death is younger

Question 2

Symptoms of Parkinson’s

Answer 2

• Tremor – specifically, a resting tremor
• Bradykinesia (yeah!) – slowness of movement
• Muscle Rigidity
• Postural Instability/Balance Problems
• Causes incapacitation that makes it easier for you to get pneumonia, infections, breathing problems etc

Question 3

Tremor

Answer 3

• Resting tremor – ~4-5 movements per sec w/ movements occurring when individual not actively engaging in motor behavior
• Pill-rolling – classic Parkinsonian tremor: thumb rubs against index and middle fingers
• Tends to start only in one limb, mainly hands/feet before knees/elbows, but eventually spreads
• Often is demonstrated before rigidity and instability start

Question 4

Rigidity

Answer 4

• muscle stiffness
• worse w/ progression
• “Cogwheeling”: pt make full circle with arms (rockstar)– rather than smooth, it will look like a ratchet. Often seen in the wrist in early stages
• Lead-Pipe rigidity – can’t move a limb at all.
• Mask-face – no longer make facial expressions; late stage symptom

Question 5

Gait Instability

Answer 5

• shuffling walk with a forward-flexed posture causing to lose balance & fall, broken bones. esp older

Question 6

Parkinson’s Etiology

Answer 6

• degeneration of the dopamine-producing cells of the basal ganglia (accumulation of proteins); specifically, substantia nigra (pars compacta).
• area of the brain responsible for motor coordination, planning, and intentional movements & reward, learning, and pleasurable feelings
• similar to DLB

Question 7

Tx of Parkinson’s

Answer 7

• Primary treatment=L-DOPA
• cholinergics for rigidity
• sideffect:psychosis
• Deep Brain Stimulation (DBS) – a lead with electrodes is inserted in the brain, attached to a battery pack usually placed under the clavicle (electrodes block the signals from being sent)
• Highly effective but eventually resistance is built
• Surgical risk is minimal

Question 8

Neuropsychiatric Deficits

Answer 8

• personality change
• depressive episode
• slowed motor speed
• therapy and medication

Question 9

Sequelae of Parkinson’s Tx

Answer 9

• psychosis
• risk of developing symptoms like apathy, mania, hypersexuality, and compulsive disorders like gambling.

Question 10

Differential Dx for Parkinson’s

Answer 10

• DLB/AD – do motor symptoms occur at the same time as cognitive ones, or does one occur before the other?
• Tremor – resting vs. action vs. postural vs. essential
• Parkinson’s PLUS – symptoms of PD plus atrophy in any number of cortical areas
• Dementia Pugilistica
• Drug-induced Parkinsonianism

Question 11

Outcome

Answer 11

• No Tx but symptoms can usually be controlled
• Psychotherapy
• PT and OT and Speech Therapy for muscular problems
• Length of medication treatment without building resistance is important prognostic indicator.