Parkinson's Disease (PD) Flashcards
What are some common difficulties in gait with patients who have Parkinson’s disease?
- Reduced walking speed / Shuffling steps
- Bradykinesia
- Freezing
- Festination
- Difficulty turning
- Reduced arm swing
- Weakness
- Sensory loss
What is the 2nd most common neurodegenerative disorder in the world?
Parkinson’s disease
Is Parkinson’s disease more common in men or women?
Men
What is Parkinson’s disease?
Complex & progressive disorder characterised by various motor and non-motor symptoms
What are some features of Parkinson’s disease?
- Resting tremor
- Rigidity
- Postural instability
- Bradykinesia
What part of the brain does Parkinson’s disease affect?
Basal Ganglia
What are the (5) nuclei that make up the basal ganglia?
- Caudate Nucleus (Striatum)
- Putamen (Striatum)
- Globus Pallidus-internal and external segments
- Subthalamic nucleus
- Substantia Nigra
What are the (3) different dopamine pathways?
- Mesocortical
- Nigrostriatal
- Mesolimbic
What does the mesocortical dopaminergic pathway effect?
-Cognition
- Memory
- Attention
- Emotion
- Behaviour
- Learning
What does the nigrostriatal dopaminergic pathway effect?
Movement Control
What does the mesolimbic dopaminergic pathway effect?
- Pleasure
- Reward seeking behaviours
- Addiction
- Emotion
Describe the circuitry of the Basal Ganglia.
- Provides a feedback circuit.
- It receives informationfrom several sources including the cerebral cortex (sensory and motor areas).
-The input information enters via the striatum and leaves via the globus pallidus. - Itfeeds this information to the cortexvia the thalamus.
What are some of the main criteria to be diagnosed with Parkinson’s disease?
- Bradykinesia
- Stiffness
(and/or) - Tremor
- Balance & gait disorder
What are the (3) stages of Parkinson’s disease?
- Preclinical: neurodegeneration presentbut asymptomatic
- Prodromal Parkinson’s Disease:motor and non-motorsymptoms arepresent with clinical diagnosis
- Clinical Parkinson’s Disease: dopamine-responsive with bradykinesia
How is gait affected in Parkinson’s Disease?
- COG anterior
- Short steplength
- Flexed posture
- Reduced arm swing
- Hypokinetic
- Festinating
How does bradykinesia present in Parkinson’s Disease?
Slowness of movement:suppression of movement in the cortex due toincrease inhibition
How does rigidity present in Parkinson’s Disease?
Stiffness: typicallylead-pipeor cogwheelin the presence of a tremor, due to depletion of dopamine
How does a tremor present in Parkinson’s Disease?
Primarily resting ‘pill rolling’
How does postural instability present in Parkinson’s Disease?
Flexed posture
What are some of the less recognised early presentations of Parkinson’s disease?
- Handwriting
- Loss ofsmell
- Slow initiation
- Freezing
- Festination
- Dyskinesia
- Dystonia
What are some non-motor features of Parkinson’s disease?
- Neuropsychiatric symptoms: Depression, Anxiety
- SleepDisorders:restless legs,insomnia
- AutonomicSymptoms: bladder andbowel,excessive sweating, sexual dysfunction
- Gastrointestinal:constipation
- Dribbling (difficulty managing their saliva)
- Sensory Disturbances: pain
- Fatigue
- Nutritional issues / weight loss
What are (2) medical managements of Parkinson’s disease?
- Levodopa (dopamine)
- Deep brain stimulation surgery
What are non-medical managements of Parkinson’s disease?
Team management is key
- Enable activity
- Enable participation
- Quality of life
- Symptom control
What can we offer as physios for patients with Parkinson’s disease?
- Self-management
- Prevent inactivity
- Prevent fear to move andfalling
- Improve physical capacity
- Reduce pain
- Delay onset activity limitations
- Functional ability: transfers, gait, manual activity
- Maintain vital functions
- Prevent pressure sores
- Prevent contractures
- Support carers
What are some things to consider during a Parkinson’s disease assessment?
- Drug history: timing of medication is vital
- Expectations and goals
- Carer support
- Falls
- Non-motor symptoms
What are some elements of objective assessment to complete for patients with Parkinson’s disease?
- Observation during functional activities: tremor, dyskinesia, bradykinesia, balance
- Range of movement and activity/power: trunk, LL and UL.
- When assessing tone feel for - Rigidity- axial rotation, LL, UL
- Sensation and proprioception
- Coordination
- Balance: perturbation,reactions, visual input
- Gait:freezing,dual tasking,outdoor/ uneven
- Functional: on/off floor,rolling, ly-sit,running, cycling, R&G,car transfers
- Confounding factors: processing speed, problem solving, pain, fatigue
- Respiratory function and pain management if appropriate
What is the exercise framework for patients with Parkinson’s disease?
- Progressive resistance strength training
- Cardiovascular training
- Specific training (e.g., Nordic walking/balance training)
How much exercise is recommended for patients with Parkinson’s disease?
- 2.5 hrs of moderate to vigorous exercise a week
- Progressive resistance exercise for 2 days a week
- Specific prescribed exercise (dual tasking/flexibility) 2 days a week
Describe the pathophysiology of Parkinson’s disease.
- Programmeddestructionof>70%of neurons resultingin depletion of the neurotransmitter dopamine in the substantianigra
- This leads to changes in the basal ganglia circuitry and the features of PD (e.g., more inhibition (stop) of the thalamus leads to depressed or slow movement)
- Impacts limbic and cortical pathways: leading to apathy, memory problems, depression + sleep disorders
What are some examples of exclusion criteria for Parkinson’s disease?
- History of repeated strokes with stepwise progression of parkinsonian features
- History of repeated head injury
- Strictly unilateral features after 3 years
What are positive criteria for Parkinson’s disease?
Three or more required for diagnosis of definite Parkinson’s disease in combination with diagnosis:
* Unilateral onset
* Rest tremor present
* Progressive disorder
* Persistent asymmetry affecting side of onset most
* Excellent response (70-100%) to levodopa
* Severe levodopa-induced chorea
* Levodopa response for 5 years or more
* Clinical course of ten years or more
What will physios need to be able to manage when it comes to Parkinson’s disease?
- Mechanical pain (Shoulder, lower back)
- Muscle weakness
- Stiffness
- Falls & Fractures
- Balance
- Reduced exercise tolerance
- Social isolation
- Reassurance
- Functional practice
- Pain (Neuropathic)
- Pressure relief
- Chest infections
- Contractures
- Support to family and carers
- Advice (t/f, manual handling)
What are symptoms of Parkinson’s disease caused by?
Decrease in dopamine neurotransmitter
