Parkinson's Dz Flashcards
PD
Who?
- Older
- Male >
- Idopathic > Genetic
- Most : Tremulous PD
- Rest: Atremulous, postural instability Rigidity
PD
Path
*Progressive Lewy Body accumilation (brainstem/cortex) : a-Synuclein
- Dysfunctional Circuitry
- Nigro-Striato-Thalamo-Cortical Network
*Neurodegeneration
PD
Braak Stages
BRAAK
- Stg 1-2: Autonomic + olfactory
- Stg 3-4: Sleep + Motor
- Stg 5-6: Emotional + Cognitive
Tremor Patho
Pallidium
Retrorubral area A8 (Dopamine)
Tremor on/off
S/s
slowness/paucity of executing movement
Bradykinesia
S/s
- Up tone
- velocity-independent
Muscular Rigidity
*cogwheel = rigidity + tremor
S/s
Postural instability
Primary
*NOT visual, proprioceptive, vestibular, cerebellar
Tremors
Action - Postural
Sustained posture against gravity (extended arms, holding newspaper)
Tremors
Action Kinetic
- goal directed / intention (nose to finger, drinking glass of water)
- task specific
other Non-motor S/S
- Sensory = Pain, olfactory
- GI = Constipation, dribbling, Nocturia
- Sleep Disorders = REM sleep behavior disorder
- Autonomic = Ortho HypoTN, Bladder Dysfunction
- Neuropsychiatric = Depression
- Dopa-induced = Impulse control (sexual),
Differential
Neurodegenerative :
Parkinson Plus Disorders
Synuclein vs Tau - Based
Synuclein
- Mutliple System Atrophy
- Lewy Body Dementia
Tau
- Corticobasal Degeneration
- Progressive Supranuclear Palsy
Parkinson S/S Differential
- Neurodegenerative : Parkinson + Disorder
- Ischemic - vascular parkinsonism
- Rxs: Neuroleptics, Anti-Emetics (Metoclopramide)
- Post-infectious: Flu
- Toxin : MPTP Manganese
Dx
*Parkinsonism = bradykinesia + 1 (rest tremor, rigidity)
=MOTOR (bradykinesia, rigidity, postural instability + NONMOTOR (Anosmia, Constipation, RBD/Fatigue, Nocturia, Dementia
- Gradual onset= noticed by others
- rest tremor = asymmetric, upper extremities
DX
on Dopa-blocking Rx:
FALL RISK
Neuroleptic, metoclopraminde
DX
- sudden onset
- lower extremity symmetry
- Orthostatic HypoTN
- falls
Vascular Parkinsonism, Parkinson + DIsorders
FALL RISK
