Parkinsons Disease Flashcards
What are the 4 cardinal signs of Parkinsons disease?
Rigidity
Bradykinesia
Tremor
Postural Instability
What are some non-motor signs of Parkinsons?
Loss of sense of smell Constipation REM sleep behavior disorder Mood disorders Orthostatic Hypotensions
What’s the average age of onset for Parkinsons?
50-60 years old
How old does a patient need to be to be considered Young-onset PD?
21-40 years old
What causes Parkinson’s?
Idiopathic
Genetic (
What can cause secondary parkinson’s?
Awakenings (viral encephalitis)
Toxic Parkinsonism
Drug-Induced
What are some parkinson-plus syndromes?
Striatonigral degeneration
Shy-Drager Syndrome
Progressive Supranuclear Palsy
Name some other diagnosis’s that can cause parkinson-like symptoms.
Lewy Body Dementia
Normal pressure hydrocephalus
Alzheimer’s Disease
Name the main part of the brain affected by Parkinson’s
Basal ganglia
What are the 3 things that happen in Parkinson’s disease?
Degeneration of neurons in basal ganglia (substantia nigra) that produce dopamine
As it progresses presence of cytoplasmic inclusion bodies called lewy bodies
Substantial neurodegeneration occurs in PD before onset of motor symptoms (30-60& degeneration)
Besides the cardinal 4 motor symptoms of PD, name some other motor symptoms.
Akinesia
Hypomimia (masked facial expression)
HypoKinesia (decreased amplitude of movement)
Micrographia (small handwriting)
Are strength and planning deficits primary or secondary motor symptoms?
Secondary
What are some common gait abnormalities with Parkinson’s?
Reduced arm swing Stooped Posture Festinating gait Difficulty turning Loss of balance with retrowalking
What are some sensory symptoms you may see in a patient with PD?
Parasthesias
Postural stress syndrome
Impaired proprioception and kinesthesia
Olfactory dysfunction (often years before motor symptoms)
What is hypokinetic dysarthria?
Decreased volume of voice
Name some common cognitive dysfunctions with PD?
Dementia (20-40%)
Bradyphrenia (slowed thinking)
Hallucinations, delusions, psychosis, (L-dopa toxicity)
True or False: Depression and Anxiety are common in PD?
TRUE: both are common
What are some sleep disorders associated with PD?
Daytime sleepiness
Insomnia
REM sleep behavior disorder (act out dreams)
What is the only accurate way to diagnose PD?
Continued observation of evolving clinical signs and symptoms
-No single definitive test or group of tests
How many cardinal motor features are necessary to typically make a diagnosis of PD?
2/4
How can you tell the difference between PD and PD-Plus syndrome?
PD affects 1 side more
PD-Plus presents bilaterally (doesn’t respond to L-dopa either)
What are the most common causes of death with someone with PD?
Cardiovascular disease
Pneumonia (risk of asperation due to dysphagia)
What is the “gold Standard for measuring progression of PD”
Unified Parkinson’s Disease Rating Scale (UPDRS)
Name the 4 parts of UPDRS
Mentation, behavior, mood
ADLs
Motor Exam
Complications of drug therapy
Describe the Hoehn-Yahr Classification of disability
Stage 1 = Minimal/absent unilateral if present
Stage 2 = Minimal bilateral or mid-line involvement, (balance not impaired)
Stage 3 = Impaired righting reflexes, unsteadiness when rising from chair, can live independent
Stage 4 = All symptoms present and severe, standing & walking possible with minA
Stage 5 = Confined to bed or wheelchair
What is the focus of medical management of PD?
Slow progression using neuroprotective strategies and symptomatic treatment
- Pharmacological
- Nutritional
- Deep brain stimulation
What’s the gold standard drug for PD?
Levodopa/Carbidopa (Sinemet)
- Short half life (consistent timing is key)
- Honeymoon period (dramatic improvements at first)
What are some adverse affects of Levodopa?
Window is 4-6 years before benefits wear off
Significant number of patients develop dyskinesias, dystonia, and motor fluctuations when this happens (gets 10% worse each year)
On-off phenomenon
What’s a dyskinesia?
Uncontrolled or involuntary movement
-Occurs at peak dose of L-dopa
What is Dystonia?
Prolonged involuntary contraction that causes twisting or torsion of body segments (clawing fingers/toes, cramping)
What are some common dopamine agonist and what do they do?
Requip, Mirapex
Stimulate postsynaptic dopamine receptors
-Linked to increased risk of impulse control disorders
What blocks cholinergic function and most benefits moderating tremor and dystonia?
Anticholinergics
What is the name of the drug that stops an enzyme from breaking down dopamine and is given early on in PD cases to increase dopamine
Monoamine Oxidase B Inhibitors (MAO-B)
When do you want to time your therapy sessions for a PD patient?
When they are during their optimal dose of medication
Name something in your diet that can block the effectiveness of L-Dopa?
High-Protein
When is the optimal time to take Sinemet in correlation with meal time?
30 minutes before or 60 minutes after a meal
How does deep brain stimulation work?
Electrodes placed in the brain block nerve signals that cause symptoms (subthalamic nucleus or globus pallidus)
What are some adverse side-effects of DBS?
Confusion, headache, speech complication, gait disturbances and falling
