PD Flashcards
PD is the a common neuro disorder second only to what condition
Alzheimer’s
PD is the most common _____ disorder
movement
Generally when is PD diagnosed
50-60 years
what is the primary cause of PD
most cases are idiopathic
though PD as we traditionally talk about it is generally idiopathic, what are three common causes of Secondary Parkinsonism?
postencephalitic parkinsonism
toxic parkinsonism
drug-induced (haldol) parkinsonism
What are the three common categories of PD
- PD
- Secondary Parkinsonism
- Parkinson-Plus Syndromes (atypical PD)
what anatomy is implicated in PD?
the basal ganglia
what role does the BG play in PD?
voluntary movement and postural adjustments - i.e. the dog leash that pulls in or lets out motor function
What is the pathophys of PD
dopaminergic neuron degeneration
T/F: patients will begin to demonstrate sxs of PD as dopaminergic neurons degenerate
false: patients will not show clinical sxs until 60-80% degeneration
How can a clinician distinguish between Parkinson Disease Dementia and Lewy Body Dementia?
PDD presents as PD then cognitive changes follow at least 1 year after dx. LBD presents as PD with concurrent cognitive changes within 1 year of dx.
what are the four cardinal features of PD
- bradykinesia
- tremor
- rigidity
- postural instability
describe bradykinesia as a cardinal sign of PD
the most common cardinal feature that can present as festinating gait, micrographia, hypomimia (masked facies), and/or freezing episodes
describe tremor as a cardinal feature of PD
the first cardinal symptom in 50% of patients most often seen as a pill rolling resting tremor
describe rigidity as a cardinal feature of PD
- velocity independent
- reflexes may be normal
- cogwheel - stopping/catching throughout ROM
- lead pipe - pushing through constant arc of motion resistance
- trunk rigidity
describe postural instability as a cardinal feature of PD
difficulty in anticipatory movement and posture shifted anteriorly
what does it take to clinically dx PD?
2/4 cardinal features and dx of exclusion - though imaging (DaTSCAN, PET, SPECT) is becoming more popular/useful
What are the three most common Parkinson Plus Syndromes
- Progressive Supranuclear Palsy
- Corticobasilar Degeneration
- Multiple System Atrophy (Shy Drager Syndrome)
What is Progressive Supranuclear Palsy (PSP)
- a clinical mimic of PD but dominated by frontal lobe sxs
- Hallmark signs - rocket sign (forcefull STS followed by a push back) and inability to gaze downward (looking up a lot)
What is corticobasal degeneration
- clinical mimic of PD BUT PD MEDS DONT HELP
2. remarkable rigidity and ataxia
What is the key to understanding multiple system atrophy (Shy Drager Syndrome) as an offshoot of PD?
Autonomic presentation is key (dizziness, fainting, orthostasis)
Discuss the course of disease for PD
though pathology precedes dx by years, tremor dominant PD has a better prognosis and can be rather benign
what is the mainstay medical tx for PD
Sinemet (levadopa and carbidopa) - i.e. dopamine replacement therapy
describe the implication of dopamine replacement therapy
impact deteriorates over the course of the disease resulting in an on-off phenomenon therefore some patients take drug holidays
T/F: there is no surgical management for PD
false: DBS can significantly improve function in PD patients
what are two postural deformities/dystonias that are common in PD patients
- camptocormia - bent spine syndrome (flexed in sagittal plane)
- pisa syndrome - lateral spinal flexion (frontal plane)
what are two measures specific to PD
H&Y and UPDRS
how do you address the phantom pillow phenomenon in PD patients?
prone tasks
what should you do to combat postural changes in PD patients
tai chi, rocking and rotation movements, PNF patterns
what intensity of task specific training (functional mobility, balance, gait) is appropriate for PD patients
high
what are ideas to combat trunk/pelvis stiffness in PD patients
pelvic clock, swiss ball, bridging, scooting
what is a good idea to help encourage dopamine uptake during exercise
large amplitude movement
T/F: treadmill training is inappropriate for PD patients
false - high intensity training is recommended
what is a strategy you can use with PD patients to make their movements more effective?
external cues (such as auditory or visual cues) engage CB and cortical areas of the brain
T/F: high intensity exercise is neuroprotective in PD patients, not neurodegenerative
true
though Tai Chi does not have any evidence to support impact on gait and QoL, what does it do?
it is safe, popular, and has a positive effect on motor function and balance
what type of AD could be most beneficial for PD patients
U-step walker
Research says that THIS adjuvant to exercise and rehab improves symtpoms of PD
forced exercise cycling/theracycle - which mechanically augments exercise rate greater than the preferred voluntary rate
