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DM Neuro 1 > Parkinson's Disease Pt 2 > Flashcards

Parkinson's Disease Pt 2 Flashcards

1
Q

PD gait can be broken down into what 2 categories?

A
  1. continuous characteristics
  2. episodic characteristics
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2
Q

Describe continous characteristics of PD gait

A
  1. overall hypokinetic presentation
    • slower steps, smaller steps, reduction in arm swing, minimal trunk rotation
    • LE rigidity
    • axial rigidity
      • stooped posture, en bloc turning style
  2. increased variability and asymmetry
  3. poor postural control
    • achieving, maintaining, and restoring balance all impacted
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3
Q

As PD progresses how do continuous characteristics of PD gait change?

A
  1. shuffling gait patterns emerge
    • Festinating gait becomes more continuous
  2. increased tendency for retropulsion and/or anteropulsion
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4
Q

T/F: episodic characteristics can turn into continous characteristics as PD progresses?

A

TRUE

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5
Q

Describe episodic characteristics of PD gait

A

early and middle stages of PD

  1. Festinating gait pattern
    • unintentionally quick, shuffled steps that worsens as gait progresses
  2. Midline disorientation
    • anteropulsion or retropulsion
  3. En Bloc Turning
    • strategy to overcome sig difficulties w/turning
  4. Freezing of gait
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6
Q

describe en bloc turning

A
  1. decreased rotation of head, trunk pelvis to complete turns
  2. increased instabilities observed during turns
  3. reduced speed, more steps to complete turns
  4. can be further impacted by increased postural tone, axial rigidity, and/or loss of flexibility
    • also impacted by impaired MC, bradykinesia, freezing
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7
Q

describe freezing of gait

A
  1. Brief, episodic absence or marked reduction of forward progression of the feet despite the intention to walk
  2. Mechanism of FOG not well understood
    • triggered by confrontation of competing stimuli
      • turning, walking through doorways, variable surfaces
    • can be exacerbated by stress, fatigue, distraction
    • worsens w/disease progression
    • possible links to long-term levodopa use?
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8
Q

List Non-motor symptoms of PD

A
  1. Loss of smell
  2. sleep disturbances
  3. constipation
  4. pain and paresthesias
  5. visual impairments
  6. OH (may or may not be symptomatic)
  7. fatigue
  8. urinary symptoms
  9. apathy
  10. early mild cog impairment
  11. dementia
  12. depression
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9
Q

describe the non-motor symptom of pain in PD

A
  1. 60-80% of pts experience pain as early symptom
  2. MSK, dystonic, neuropathic, central, and akathisia
  3. central pain thought to be due to abnormal modulation of pain caused by dopamine deficiency
  4. common areas:
    • lower back
    • legs
    • shoulder
    • face
  5. hypersensitivies common
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10
Q

Define akathisia

A

inner restlessness and inability to remain still

sort of like restless leg syndrome, you have to keep moving or you get very uncomfortable

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11
Q

List the PD subgroups

A
  1. Postural Instability Gait Disorder (PIGD) phenotype
    • 25% of all PD cases
    • dominant symptoms: postural instability and gait disturbances
    • more sig disease course
  2. Tremor-dominant phenotype
    • typically demo fewer problems w/bradykinesia or postural instability
    • lower prevalence of non-motor symptoms
    • less likely to develop dementia and other cog deficits
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12
Q

List and describe the 5 stages of PD via the Hoehn and Yahr scale (H&Y)

A
  1. Stage 1 → unilateral involvement only usually w/minimal or no functional disability
  2. Stage 2 → bilateral/midline involvement w/o impairment of balance
  3. Stage 3 → bilteral disease: mild-to-moderate disability with impaired postural reflexes; physically independent
  4. Stage 4 → severely disability disease; still able to walk or stand unassissted
  5. Stage 5 →confinement to bed or wheelchair unless aided
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13
Q

List drugs included in the medical management of PD

A
  1. Carbidopa and Levadopa (Sinamet)
  2. Dopamine agonists
  3. Catechol-O-methyltransferase (COMT) inhibitors
  4. Monoamine oxidase-B (MAO-B) inhibitors
  5. Anticholinergics
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14
Q

what are some med considerations for pts w/PD?

A
  1. early initiation of pharmeceuticals are shown to help with progression of disease long-term, but prolonged trx can lead to dyskinesis
  2. On/Off times
  3. Levadopa does not improve all PD symptoms
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15
Q

what types of symptoms does levodopa not improve in PD pts?

A
  1. does not improve axial rigidity
  2. typically worsens postural responses to external perturbations
  3. shown to improve hypokinetic gait in the early stages of PD but tends to be less effective at improving gait as the disease progresses
  4. generally improves freezing of gait in the “OFF” state but not during the “ON” state
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16
Q

are there any surgical options for PD?

A

Yes

  1. Deep Brain Stimulation
    • typically reserved for bradykinesia, rigidity and tremor in pts who no longer respond to meds in a predictable manner or who suffer med-induced dyskinesia
    • can increase ON periods, reduce frequency of OFF periods, and lead to a reduction in many PD symptoms
    • ablation procedures like radiofrequency, radiosurgery and forced ultrasound are also utilized for select tremor symptoms
17
Q

what is the prognosis typically like for PD?

A

variable

  • disease can progress very quickly or can go several decades with only mild limitations
  • typcially does not lead to mortality
  • life expectancy often just slightly less than average
  • common secondary sequalae can lead to death:
    • CHF
    • pneumonia
18
Q

List negative prognostic indicators for PD

A
  1. degree of symmetry of symptoms
  2. PIGD phenotype
  3. higher baseline UPDRS motor scores
    • higher bradykinesia sub-scores
    • higher baseline H&Y stage
  4. Age at onset
  5. Early cognitive decline or baseline cognitive impairment
  6. Smoking history
  7. Male gender
19
Q

List Body Structure and Function outcome measures relevant to PD

A
  1. Mini BESTest
  2. Montreal Cognitive Assessment
  3. STS x5
  4. MDS-UPDRs revision - part 1 and 3
  5. TUG
20
Q

List Activity and Participation outcome measures relavant to PD

A
  1. 6 minute walk test
  2. 10 MWT
  3. Mini BESTest
  4. FGA
  5. STS x5
  6. 9 hole peg test
  7. MDS-UPDRS revision part 2
  8. TUG
  9. Freezing of gait questionnaire
  10. Parkinson’s fatigue scale
21
Q

List participation outcome measures relevant to PD

A
  1. PDQ - 8 or PDQ-39
  2. Activities specific Balance Confidence Scale
22
Q

Describe the PDQ-39

A
  1. Evaluates PD-specific health related QOL over the last month
  2. Includes 8 domains:
    • Mobility
    • ADLs
    • Emotional well-being
    • Stigma
    • Social support
    • Cognition
    • Communication
    • Bodily discomfort
  3. closely correlates w/H&Y, better contruct validity than generic measures (SF-36)
23
Q

Describe the MDS-UPDRS

A

Comprehensive assessment to monitor the burden and extend of PD across the longitudinal disease course

4 parts:

  1. Part 1 → Non-motor experiences of daily living
    • cognition, emotions, hallucinations, depression, anxiety, apathy, etc
  2. Part 2 → Motor experiences of daily living
    • speech, saliva/drooling, chewing/swallowing, eating, dressing, hygiene, tremor, transferring, walking, etc
  3. Part 3 → Motor examination
  4. Part 4 → Motor complications
    • functional impact of dyskinesias, OFF states, functional impact of dystonia, etc.
24
Q

when might the MDS-UPDRS be used?

A

clinical research

or use one portion during a clinical exam

25
Q

describe the MoCA

A

Montreal Cognitive Assessment

  1. rapid screen of cog abilities designed to detect dysfunction
  2. common component of OT evals
  3. 16 items, 11 categories
    • visuospatial/executive function, naming tasks, memory, attention, language, abstraction, orientation
  4. Cut off score >/= 26 points considered normal cog function
26
Q

describe the Parkinson’s Fatigue Scale

A

reflection of physical aspects of fatigue

  1. measures presence of fatigue and impact on daily function
  2. excludes cog and emotional features of fatigue
  3. excludes severity and frequency of fatigue symptoms
27
Q

Describe the Freezing of Gait Questionnaire

A

Assess FoG severity unrelated to falls in pts w/PD

  • 6 item questionnaire
    • 4 questions on FoG frequency
    • 2 questions on disturbances in gait
  • correlates well w/H&Y stages

DM Neuro 1 (16 decks)

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