Parkinsons + Parkinsonism Flashcards
What are the 3 main groups of movement disorder?
- Pyramidal
- Hyperkinetic
- Hypokinetic
What 2 movement problems are pyramidal?
- Pyramidal weakness
* Spasticity
Name the 5 main hyperkinetic movement disorders.
- Distonia
- Tics
- Myoclonus
- Chorea
- Tremor
Name the 3 main hypokinetic movement disorders.
- Rigidity
- Bradykinesia
- Parkinsons
Extrapyramidal movement disorders can be either ___________ or __________
- Hyperkinetic
* Hypokinetic
What area of the brain do extrapyramidal movement disorders involve?
Basal ganglia
What are of the brain does pyramidal movement disorders involve?
Corticospinal or pyramidal tract
What 3 things does a ‘parkinsonian’ syndrome refer to?
- Rigidity
- Akinesia/bradykinesia
- Resting tremor
What is dystonia?
Prolonged muscle spasms and abnormal postures.
What is chorea-ballismus?
Fragments of movements flow irregularly from one body segment to another, causing a dance-like appearance.
When can the term ballismus be used?
Amplitude of movements is large
What is the basal ganglia?
A collection of grey matter with important connections to many other parts of brain
What is the basal ganglia important for?
Movement co-ordination
What motor features does PD present with?
Tremor, muscular rigidity, akinesia, rest tremor, gait and postural impairment.
Motor features in PD are heterogenous
T
There are 2 main groups of motor symptoms in PD. Name these.
Tremor dominant PD – with relative absence of other motor sx
Non-tremor dominant PD – such as akinetic-rigid syndrome and postural instability gait disorder.
Also, mixed/intermediate phenotype
There course and prognosis of the 2 types of PD motor symptoms are different
T
What is the progression and course like of the ‘tremor dominant PD’?
Slower rate of progression and less functional disability.
What do the non-motor features of PD include?
- Olfactory dysfunction.
- Cognitive impairment.
- Psychiatric sx.
- Sleep disorders.
- Autonomic dysfunction.
- Pain.
- Fatigue.
Non-motor sx are common in early PD (as well as before the onset of motor features), and are associated with reduced health-related quality of life.
T
When do the non-motor symptoms of PD usually present?
Before the onset of the motor symptoms
List the main motor features of PD.
- Tremor
- Bradykinesia
- Rigidity
- Postural instability
List some non motor features of PD that patients might present with.
Sleep disorders, hallucinations, GI dysfunction, depression, cognitive impairment/dementia, anosmia.
When can a resting tremor be seen?
When the pt is sitting with their hands on their lap
Cog-wheel rigidity is characteristic of PD
T
Describe pin rolling.
This is another characteristic tremor seen in PD - basically imagine someone rolling a pin between their thumb and index finger (pronation and supination)
When is PD usually diagnosed?
When motor symptoms onset
Non-motor symptoms can be present for more than a ______ before onset of motor symptoms
Decade
The pathogenic process that causes PD is presumed to be underway during what? What does this involve?
- The premotor phase.
Involves the regions of the peripheral and central nervous system, in addition to the dopaminergic neurones in the SNpc (Substantia Nigra Pars Compacta)
What is the progression of PD characterised by?
Worsening motor features, which initially respond well to symptomatic therapies (‘honeymoon phase’).
What are the advance stages of PD characterised by?
The emergence of complications related to long term symptomatic treatment, including motor and non-motor fluctuations, dyskinesia and psychosis.
In late-stage PD treatment, resistant motor and non-motor features are prominent. What do these include?
Axial motor symptoms …
- Postural instability
- Freezing of gait
- Falls
- Dysphagia
- Speech dysfunction
Dementia occurs in __ % of PD patents
83%
What kind of sleep disorder to people with PD get?
REM sleep behaviour disorder
What is a REM sleep behaviour disorder?
Parasomnia - abnormal and disruptive behaviour during sleep
What kind of odd sleep behaviours is seen in someone with PD?
- Talking
- Laughing
- Shouting
- Gesturing
- Grabbing
- Punching
- Kicking
- Sitting up in bed
Dreams are ________ during REM sleep disorders in PD patients
Enhanced
The disordered sleep behaviours that people with PD have is during REM sleep
T
How is REM sleep behaviour disorder in PD patients treated?
Clonazepam / Melatonin at bedtime
How is REM sleep behaviour disorder in PD patients diagnosed?
Overnight polysomnography