Parkinson's Disease/Test 3 Flashcards
Etiology of Parkinson’s Disease:
- Diagnosis increases with age, with peak onset being in 70’s.
- Onset before age of 50 is likely r/t genetic defect
- More common in men, ratio 3:2
- *Dementia occurs in up to 40% of patients
Pathophysiology of Parkinson’s Disease:
- Chronic, progressive, degenerative disorder
- Affects dopamine-producing neurons in the brain
- Caused by an imbalance of two neurotransmitters
- dopamine
- acetylcholine (ACh)
Symptoms of Parkinson’s do not occur until
80% of neurons in the substantia nigra are lost
Basal ganglia-
- Refining motor skill
- mass of gray matter or cell bodies deep within the cerebrum. Functions adjustment of posture and gross volunteer movement. Consists of putamen, caudate nucleus and globus pallidus.
Dopamine and acetylcholine are:
primary neurotransmitters responsible for controlling and refining motor movements and having opposite effects.
Dopamine has:
inhibitory effects
Acetylcholine has:
excitatory effects
At the cellular level-
impairment of the extra pyraminal tract (controls semiautomatic and coordinated movement Striatal degeneration destruction of dopaminergic neurons reduces availability of dopamine (inhibitory neurotransmittor)
Symptoms of Parkinson’s disease: Motor
- Tremor at rest
- Bradykinesia
- Rigidity
- Postural instability
- Other (e.g. dysarthria (speaking difficulty due to mucle tone) shuffling gate, dystonia)
Symptoms of Parkinson’s disease: Nonmotor
- Neurosychiatric (eg, dementia, cognitive decline, depression, anxiety, psychosis, apathy)
- Sensory (eg, hyposmia, pain, paresthesias
- Sleep disturbances (eg, RBD, RLS, sleep apnea, sleep attacks, daytime somnolence, insomnia)
- Autonomic dysfunction
- other. (eg. fatigue, weight loss)
Parkinson’s disease progression of movement disorder:
- Onset is gradual and insidious, with a gradual progression and a prolonged course
- May involve only one side of the body initially with mild tremor, slight limp, or decreased arm swing.
- The classic manifestations of PD often include tremor, rigidity, and bradykinesia, which are often called the triad of PD.
- Later signs may have shuffling, propulsive gait with arms flexed and loss of postural reflexes.
Clinical manifestations of Parkinson’s disease:
*Gradual and insidious progression and prolonged course
Classic symptoms: TRAP- T is for
Tremors: pill rolling
- Most recognized and least disabling symptoms
- rhythmic movement of thumb across the palm at rest but not during sleep- seen in limbs, jaw, lip, lower facial muscles and head.
R is for
Rigidity- muscles feel still and require increased effort to move, stiffness may have accompanying pain
A is for
Akinesis/bradykinesis
slow, can’t initiate movement. Difficulty initiating movement. Interferes with ADL’s. Predisposes to complication r/t constipation, circulatory stasis, skin breakdown, and other mobility issue
P is for:
Postural instability
Change in gait, unstable gate (shuffling, propulsive, festinating, loss of arm swing, stooped, righting reflex decreased or absent. Change in balance. Stooped arms semiflexed and do not swing when walking. Difficulty maintaining balance and sitting erect. Cannot brace self or prevent falling. “Cogwheel” ratchetlike rhythmic contractures of the muscle that occur when extremities are passively stretched.
Tremor is more prominent
at rest and is aggravated by emotional stress or increased concentration.
- described as pill rolling because thumb and forefinger appear to move in rotary fashion.
- Tremor can involve diaphragm, tongue, lips and jaw, dysarthria
- Benign essential tremor, which occurs during voluntary movement, has been misdiagnosed as Parkinson’s
Rigidity is the
increased resistance to passive motion when the limbs are moved through their range of motion
- Typified by a jerky quality when the joint is moved
- Similar to intermittent catches in the movement of a cogwheel
- complaint of soreness, feeling tired and achy
- pain in the head, shoulder, neck, spine, hips or legs
- *caused by sustained muscle contraction. Inhibits the alternating contraction and relaxation in opposing muscle groups, thus slowing movement.
Emotional Problems:
*non motor symptoms are common;
-depression
-insomnia
-mood swings
-hallucinations
-anxiety
-apathy
-fatigue
-pain
-impotence
-short-term memory impairment
Misc:
-excessive salivation, dysphagia, weight loss, micrographia, seborrhea, dandruff, excessive sweating, postural hypotension
How is PD diagnosed:
- Facial appearance
- Fine motor function
- Speech problems
- Autonomic disturbances
- Dysphagia
Facial appearance:
- expressionless
- eyes are straight ahead; impaired upward gaze
- much less blinking
- mask like face
Fine motor function
- micrographia
- decreased manual dexterity
- clummsiness and decreased cordination
- decreased capacity to complete ADLs
- freezing: sudden involuntary inability to initiate movement. Can occur during activity or inactivity.
Speech problems:
- low volume
- slurred, muffled
- monotone voice
- blepharospams; ivoluntary prol
Autonomic Disturbances:
- constipation from hypomobility
- prolonged gastric emptying
- urinary frequency and hesitancy
- orthostatic hypotension; dizziness, fainting, syncopy
- dysphagia from neuromuscular incoordination
- drooling from decreased swallowing
- oily skin (seborrhea)
- excessive perspiration
