Parkinsons Disease Flashcards
What is Parkinsons Disease?
- Chronic & slowly progressive neurodegenerative disease
- Caused by selective dopaminergic cell loss
- Presently there is no cure
What are the prominant features/signs of PD?
Tremor
Ridigity
Akinesia/Bradykinesia
Postural Instability
Which of the following sign/symptom is associated with a more gradual disease progression?
A. Tremor
B. Older age of onset
C. Hypokinesia
D. Rigidity
A. Tremor - If tremor is one of the first symptoms noted then that typically indicates a more gradual disease progression
also associated with a longer beneficial reponse to L-DOPA
Imagine you completed Mr. Anand’s assessment during an “off” period. Which of the following would you not expect to see.
A. Freezing
B. ↑ resting tremor
C. Bradykinesia
D. Dyskinesia
D - We don’t expect to see dyskinesia
* Its caused by the medications that ppl use for Parkinson’s
* Everything else will go away (freezing, tremor, brady) but dyskinesia increases/lack of movement signs become more prominent
Freezing of gait is less likely to occur during which scenario?
A. When listening to music with a consistent beat
B. During an “off” period
C. In a crowded area
D. When turning
A - auditory/visual stimuli (music with metronome can be very beenficial for people to walk)
What is the average age of onset?
a) 45
b) 53
c) 61
d) 75
c) 61 - early 60’s, rarely seen before age 50
Dscribe the difference between primary parkinsonism and sceondary parkinsonism
primary - idiopathic, 78% of cases
secondary - etiology known (drugs, vascular causes, tumors, viruses/infections, toxins)
which population is this disorder more prevalent in?
men slightly higher
List the risk factors
- Age (risk ↑ as age ↑)
- Genetics
- Elevated total serum cholesterol has been linked to ↑ risk
- Higher intake of polyunsaturated fatty acids ↓ risk
- Exposure to pesticides
- Exposure to heavy metals, such as iron, manganese ,copper, lead, aluminum, zinc (inconclusive findings)
- Head injury/Hx of being knocked unconscious
- Smoking reduces one’s risk of developing PD (biological basis not understood)
- Drinking coffee also reduces one’s risk, (caffeine inhibits the adenosine A2 receptor & improves motor
deficits in a mouse model of PD). This effect may be greatest in males because estrogen is a competitive inhibitor of caffeine.
Which component of the basal ganglia is impacted in PD?
Death in substantisa nigra
True or False: Signs & symptoms of PD are not observed until 50% of dopamine-producing neurons in substantia nigra have died
True - denervation supersensitvity (increased sensitivity of a post-synaptic cell after an axon that innervated it is removed. This allows the individual to move and function relatively normally.)
If one has rigidity & hypokinesia as initial symptoms with an older age of onset, what would their clinical course look like?
rapid disease progression and earlier cognitive decline
True or false: tremors increase with mov’t and is worsened with emotional distress
False: Decreases with mov’t, worsened by emotional distress
What do you expect to see from a PD pt with bradykinesia
- Diffiuclty initiating mov’t
- Freezing
- Small handwriting
- Inability to sustain amplitude of mov’t needed for repetitive/continuous task
other than the cardinal features, list other primary impairments
- impaired ability to plan (dual tasking, terminating mov’ts, longer mov’t sequences)
- impaired motor adaptation and learning (procedural learning)
- neuromuscular weakness
- impaired swallowing
- impaired speech
- abnormal sensations/pain
- visuomotor impairments
- autonomic dusfunction
List the composite effects
- difficulty with ADLs
- flexedd posture
- difficulty initiating gait
- short shuffling steps
- freezing when changing direction
- cognitive decline
- sleep disturbances
- psychotic symptoms
- fatigue
Name the stages in Hoehn and Yahr’s Classification System
- tremor
- rigidity in gait
- falls, flexed posture
- all symptoms (shuffling steps, freezing, dementia, dysphagia, etc)
- dependent/assistance for all ADLs (respiratory complications, flexion contractures)
What is the medial management of PD?
- L-DOPA: dopamine precursor
- DBS: Implantation of electrodes into basal ganglia to treat symptoms of PD & on-off fluctuations
- Pallidotomy (destruction of GPI to reduce overactivity, reduces motor fluctuations, dyskinesia & tremor)
What are some outcome measures you could use for assessing Tremor, Rigidity and Akinesia/bradykinesia? (TRA)
Unified Parkinsons Disease Rating Scale (UPDRS)
- ordinal scale with 4 parts, each section is rated from 0-4 with 4 being severe and 0 being normal
What are some outcome measures you could use for assessing Balance/Posture?
Functional Reach Test
Berg Balance Scale
Mini-BESTest
ABC scale
What would you include in your assessment?
- sensation
- gait
- strength/MMT
- coordination (RAM, functional)
- balance/posture
- functional mobility
- resp health
- cognition/arousal/attention
subhx:
- progressing time - time of diagnosis, when symptoms began
- what were their first symptoms/current
- medications -> side effects?
- do they notice a difference when on/off medications?
- difficulty sleeping?
- have they fallen? how many?
How would you treat PD in the early stages?
Restorative & Preventative
- ROM
- strength
- motor function
- balance
- postural control
- endurance & QoL
Compensatory: aids & modifications
How would you treat PD in the middle stage?
- same preventative & restorative intervention as early stage
- Compensatory: WC, modifications
How would you treat PD in the late stages?
Restorative & Preventative
- maximize upright posure, ADLs participation
- prevent contractures, pressur einjuries, pneumonia
**Compensatory: caregiver training, aids (pressure relieving devices, WC, mechanical lift)
