Parkinson's DZ - RS Flashcards
pathology
refers to a group of disorders producing abnormalities in the BG
excessive cholinergic activity, tremor and rigidity
loss of dopamine –> akinesia, bradykinesia
tremor
most common initial clin man (75%)
how does a tremor usually appear
unilaterally in a single UE
can progress to bilateral
how are tremors first seen
pill-rolling tremor in fingers
which side to symptoms usually start on
right side
61%
tremors are present
at rest
increase in tremors
with exertion or tension
stress test
decrease in tremors
or disappear with sleep or action
tremors occur as a result
of an imbalance b/w cerebellar actions and BG inhibition
overtime…
tremor will spread to other body parts including
-legs
face (blepharospasm)
-shoulder
-neck/trunk (titubation)
how do tremors progress
unilateral –> bilateral
appendicular –> axial
reduction in
medical efficacy
progression causes
increased akinetic rigidity
postural/balance/gait disturbance
motor initiation difficulty (freezing)
speech/swallowing/drooling problems
vocal production dysfunction
non-motor symptoms
medication side effects
complications
common presenting
TRAP
shuffling gait
decreased arm swing (w/ gait)
dysphasia
micrographia
TRAP
cardinal signs
3/4 required for diagnosis
T-Trap
resting tremor
pill rolling
R- trap
rigidity
lead pipe, cogwheel
A - trap
akinesia
bradykinesia
P -trap
postural instability
late stage finding
decrease balance and coordination
Heohn and Yahr scales
stages 0-5
stage 0
no signs of dz
stage 1
unilateral dz
stage 1.5
unilateral plus axial involvement
stage 2
BIL dz w/o balance impairments
stage 2.5
mild bilateral dz with recovery on pull test
stage 3
mild/moderate BIL dz
some postural instability but physically dependent
stage 4
severe disability
still able to walk/stand unassisted
stage 5
w/c bound or bedridden unless aided
common medication
replace dopamine
block acetylcholine
neuroprotective drugs
dopamine replacement therapy
aimed at replacing deficient dopamine
Sinemet: L-dopa/Carbidopa combination
amantadine
dopamine agonists
enzyme inhibitors
L-dopa
precursor to dopamine that crosses BBB
carbidopa
given with L-dopa
inhibits the release of L-dopa in the peripheral tissue and increases it release into the brain
what does the combo do (meds)
decrease total amount of L-dopa needed
cutting down on side effects
limits bradykinesia, rigidity, tremor
what doesnt the sinemet treat
motor planning deficits
postural instability
non-motor symptoms
overtime (meds)
therapeutic window decreases and toxic window increases
side effects sinemet
dyskinesia
dystonia
on/off motor fluctuations
50-60% of people on L-dopa
will have motor complications within 5 yrs
dopamine agonists
bromocriptine (parlodel)
pergolide (permax)
when dopamine agonists are added with sinemet
decrease clinical fluctuations
what do dopamine agonists
boost output of remaining substantia nigra cells
block acetylcholine
anticholinergics
parsidol
cogentin
akinetin
artane
anticholinergics do
improve symptoms by restoring the balance of ACh and dopamine
when are anticholinergics used
less frequently than others
more used early in the dz when tremor is the most prominent problem
anticholinergics are affective for
tremor only
side effects of anticholinergics
confusion
memory
hallucinations
dry mouth
constipation
urinary retention
orthostasis
neuroprotective drugs
monoamine oxidase inhibitors (MAOs)
MAOs
neuronal degradation can be controlled with antioxidants
which control the synthesis and elimination of free radicals
problems with medical management –> sinemet
can cause dyskinesia, orthostatic hypotension, behavioral signs (confusions, hallucinations, paranoia, psychosis)
problems with medical management –> on/off
on/off phenomenon and short duration therapeutic response followed by rapid decrease in symptomatic relief
on/off phenomenon and short duration therapeutic response followed by rapid decrease in symptomatic relief
d/t the fact that PD meds are toxic to receptor site
grows more dramatic over time
“On” time becomes shorter with “off” time having dyskinesia or severe bradykinesia
“narrowing therapeutic window”
“wearing off” phenomenon
when is PT attempted
ideally during “on” time
how many respond to sinemet for a lifetime
1/3
how many respond to sinemet for 3-5 yrs
1/3
how many respond to sinemet for 5-7 yrs
1/3
