Parkinsons (Exam 4) Flashcards
Parkinson’s Disease
Chronic - Progressive - Insidious neurodegenerative disease
Not enough dopamine; imbalance between dopamine and acetylcholine
Parkinson’s: Cardinal Features
- Tremor (early
- Muscle Rigidity (early)
- Bradykinesia (early)
- Postural Instability (late)
Parkinson’s Tremor
Pill-rolling “rest tremor”
-Most notable when not engaged in purposeful activity (unlike tremors in MS and action tremors)
-Considered the least debilitating of cardinal symptoms
-May initially be unnoticeable to others: internal tremulousness w/o noticeable presence of tremor in 50% of patients
Why is the tremor is parkinson’s considered the least debilitating?
Because the tremor gets better with activity
How do tremors in parkisons start?
They start unilaterally; then spread contralaterally in several years
Parkinson’s Muscle Rigidity
COG_WHEEL
Increased resistance to PROM (jerk)
How does parkinson’s muscle rigidity start?
Starts unilaterally and then spreads contralaterally (like tremors)
Parkinson’s Bradykinesia
Generalized slowness in movement
Most difficult symptoms to desribes
What is the most major cause of disability in PD patients
Bradykinesia
How does the patient describe bradykinesia
Weakness
Incoordination
Tiredness
Parkinson’s Postural instability
Occurs later in disease process
Trouble with balance and falls
Traditionally PD has been considered to be a motor system disorders. Now it is recognized to be complex disorder that includes :
Neuropsychiatric and non-motor manifestations
Neuropsychiatric / Non motor: Clinical Manifestations
-Cognitive dysfunction and dementia
-Psychoses and hallucinations
-Mood disorders
-Olfactory dysfunction
-Sleep disturbances
-Autonomic dysfunction
-Pain / sensory disorders
What symptoms of parkinson’s may precede motor symptoms
Olfactory dysfunction (loosing smell)
Parkinson’s Autonomic dysfunction
Orthostasis
Constipation
Dyshpagesi
Diaphoresis
Urinary difficulties
Sexual dysfunction
Where might someone with PD have pain?
Face
Abdomen
Genitals
Joints
Characteristics appearance of patient with PD
Blank facial expression
Forward tilt
Slow monotonous speech
Tremor
Short shuffling gait
Micrographia in PD
Progressive shrinking of handwriting
What do we call progressive shrinking of handwriting in PD?
Micrographia
Diagnosis of PD
No specific test - based on history and clinical features
At least 2 or 3 signs of classic triad
Postive response to antiparkinsonian drugs
Parkinson’s Collaborative Care: Drug Therapy
Aimed at correcting neurotransmitter imbalance; either enhance release of dopamine or antagonize effect over cholinergic neurons
What is the drug of choice of parkisons disease?
levodopa
Levodopa
Most effective drug of symptomatic PD (particularly bradykinesia)
ON-OFF phenomenon (only effective for a certain amount of time)
Typically how long do you have before levodopa wears off?
5 years
