Parkinsons

Question 1

CNS or PNS

Answer 1

CNS

Question 2

Definition

Answer 2

CNS disorder affecting basal ganglia and other substructures

progressive, degenerative neurological condition with heteogenous onset

Hypokinetic disorder - less movement

Causes motor and non-motor impairments

Question 3

Males vs females

Answer 3

Males > females

Question 4

Age of onset/diagnosis

Answer 4

older adulthood

Question 5

What impairment is affected initially?

Answer 5

Motor first

Question 6

Aetiology (cause) of the disease

Answer 6

genetic and other factors such as environment and age

Question 7

Pathogenesis (that lead to impairments)

Answer 7

Depletion of dopamine within the basal ganglia -> causes slowed movement and loss of movement

Development of lewy bodies in various areas of the nervous system -> non-motor impairments

Question 8

Pathophysiology (deeper understanding)

Answer 8

Lack of dopamine means the striatum cannot inhibit the GPi (which inhibits the thalamus) or the GPe (which inhibits the subthalamus)

Thalamus stays inhibited and cannot excite the cerebral cortex -> cannot increase movement -> slow movement (hypokinetic - less)

Question 9

Cause of non-motor impairments

Answer 9

Development of Lewy bodies (abnormal accumulation of Ptn’s) in various areas of the nervous system (olfactory system, cerebral cortex, brain stem - postural control, autonomic functions, somatosensory)

Lewy bodies cause neurons to abnormally function and/or die

Question 10

How is it diagnosed?

Answer 10

Clinical assessment of:

1. cardinal signs
   a. bradykinesia
   b. rigidity
   c. resting tremor
2. other impairments
   a. postural instability - flexed and stooped
   b. gait abnormalities - shuffling

Question 11

Classification system

Answer 11

Hoen and Yahr stages of Parkinson’s (1-5)

Question 12

Problems

Answer 12

1. motor
   - unilateral presentation initially then bilateral

• bradykinesia
• rigidity
• resting tremor
• hypokinesia

2. non-motor
   a. cognitive
   - dementia
   - depression
   - hallucinations
   - anxiety
   - apathy

b. sensory
- loss of smell
- somatosensation: paresthesia

c. other
- bladder and bowel
- orthostatic hypotension
- insomnia
- gastrointestinal issues
- pain

Question 13

Management

Answer 13

Medial: dopaminergic (motor impairments) and non-dopaminergic (non-motor impairements)

Physiotherapy: strategies that help bypass the basal ganglia