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PD Flashcards

1
Q

1 risk factor for PD

A

age

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2
Q

etiology of PD

A

degernation of dopaminergic cells in substantial compacta
-oxidative stress
cell inability to remove toxins - free radicals - aptoptosis
programmed cell death
inc level of excitatory AA (glutamate)–> cell death

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3
Q

cause of PD

A

genetic: 15-25% people w/ PD have fam member w/ it
* tendentcy for onset to occur around same year, suggest enviro exposure

enviro: pesticides, water well, wood pulp mill, rural areas, agent orangeinverse relationship w/ nicotine

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4
Q

PD and basal ganglia

A

decreased dopamine receptors

decrease in dopamine, serotonin, norepinerphrine

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5
Q

areas of brain affected by PD (loops)

A

motor circuit
asccociative loop
limbic loop

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6
Q

PD dx

A

clinical (by reported symptoms)

dopamine transporter scan - for diff dx for atypical

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7
Q

10 common first signs of PD

A 
resting tremor
rigidity
bradykinesia
stoop posture
hypokinesia
sleep disturbances
constipation
loss of smell
micrographia
dizziness
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8
Q

tremor and PD

A

resting, keep hand in flexion to control
may involve UE or LE or both, type starts on one side
may increase when exited or anxious

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9
Q

rigidity and PD

A

primary impairment of PD
common complaint is of stiffness
severity directly related to dopamine loss
rigidity in trunk leads to decreased axial rotation

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10
Q

lead pipe rigidity

A

uniform hypertonicity throughout passive motion

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11
Q

cog wheel rigidity

A

increased resistance to passive stretch that gives way in small increments

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12
Q

clasp knife repsonse

A

characterized by a sudden decrease in resistance to passive movement

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13
Q

dystonia and PD

A

abnormal sustained muscle contraction causing twisting or turning around one or mult joints
dysfunction at basal ganglia causing excessive motor output
-early symptom or complication of tx

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14
Q

dyskinesia and PD

A

involuntary movements
looks like writhing, tics, chorea
occurs as result of med - excess dopa from replacement therapy

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15
Q

proprioception and PD

A

should be intact

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16
Q

PD mismatch b/n intended and actual output

A

believe they re moving normally when they are in fact not
true for motor and speech
**problem is central not GTO

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17
Q

PD gait devations

A 
dec stride length
dec speed
lack of heel strike
decreased or absent arm swing
decreased trunk rotation
stooped posture
festination
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18
Q

PD and freezing cause

A 
change in enviro
cognition-dual task
turning
target
initiating movement
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19
Q

PD freezing and gait

A

narrow BOS

lack of WS

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20
Q

PD cog S/s - risk

A

older age at onset
longer duration of s/s
rigidity
hallucinations or psychosis

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21
Q

PD - dementia w/ levy bodies

A

15-30% cases of cog impair
lewy body in substantia nigra
protein aggregate surrounded by fibrils (10nm)

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22
Q

PD dementia

A

no lewy body, better outcome
more responsive to DRT
ppl w/ greater mitral neuronal loss
prevalence related to age

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23
Q

PD decreased executive fx

A 
poor mental flexibility or set shifting
poor dual tasking
decreased attention
poor visual spatial orientation
impaired memory 
word finding deficits
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24
Q

PD: hoehn and yahr stage: 1

A

unilateral movement

minimal to no functional disability

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25
Q

PD: hoehn and yahr stage: 2

A

bilateral or midline involvement

w/out impairment of balance

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26
Q

PD: hoehn and yahr stage: 3

A

bilateral disease
mild-mod disability w/ impaired postural reflex
physically indep

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27
Q

PD: hoehn and yahr stage: 4

A

severely disabling disease

still able to walk and stand unassisted

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28
Q

PD: hoehn and yahr stage:

A

confined to bed or W/c unless aided

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29
Q

PD poor prognosis if presents w/

A 
older age at dx
early cog deficits
associated co morbidities 
dec repose to dopamine replacement
greater baseline impairment
dx of MSA or PSP
rigidity and bradykinesia
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30
Q

PD improved prognosis

A

right sided tremor is first symptoms

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31
Q

progressive supra nuclear palsy

A

atypical parkinsons
-loss neurons and gliosis –> neurofibrillary tangles in cerebral cortex, decreased blood flow (frontal lobe), decreased oxygen utilization in central structures
typical onset after 60, M>W severe disability 3-5 years after onset

32
Q

progressive supranuclear palsy most common first complaint

A

unsteadiness of gait w/ unexplained fallings

33
Q

how is PSP diff from PD

A

PSP progresses more rapidly, severe speech and swallowing, minimal repose to PD meds, may retropulse

lack of vertical eye movements and saccades, eventual loss of convergence, small pupil, saccadic smooth persuit

34
Q

how is PSP like PD

A 
age at onset
bradykinesia
tremor
rigid
apathy
cog impair
35
Q

multi systems atrophy includes

A

striatonigral degeneration
shy drager syndrome
oliviopontocerebellar degen

36
Q

multi systems atrophy categories

A

MSA -P: mild tremor, illness begins w/ hypotension

MSA-C: cerebellar ataxia, dysphonia w/ stridor present
*wheter they are predominately parkinsonism or cerebellar ataxia

either: autonomic dysfunction: postural hypotension, bladder, dysfunction, fecal incontinence

37
Q

MSA distinguishable from PD by

A

symmetry of signs
early presence of autonomic dysfunction
minimal tremor
lack of response and dopamine

38
Q

atypical or parkinson’s plus diff dx symptoms

A 
eye movements, PSP lack of vertical, or eye tremor
tandem balance, bicycle, potential MSA
response to meds
speed of progression
lack of progress
sever hypotension w/ postural changes
39
Q

PD med tx

A
  1. med
  2. deep brain stim
  3. PT
40
Q

levadopa

A

not started till later

41
Q

MAO-b inhibitor

A

neuroprotective benefits

may prevent breakdown of existing DA

42
Q

dopamine agonist

A

increase update of existing dopa

side effects include compulsive behavior and hallucinations- alert MD, needs to be altered

43
Q

dopamine replacement therapy

A

1/2 life = 4 hours, protein interferes w/ binding/absorption
side effect: orthostatic hypotension
complications: wearing off, dyskinesia, dystonia
*motor complications occur in 50% w/ PD after 5 years on levadopa

44
Q

DRT on off effect

A

on: meds working
off: meds not working
15-20% of its have severe motor fluctuations leading alternating periods of dyskinesia and immobility

45
Q

COMT inhibitor

A

slows breakdown of levadopa

heals w/ wearing off

46
Q

Amantadie

A

antiviral for dyskinesia (which is result of meds)

47
Q

PD consideration w/ meds and exercise

A

most commonly prescribed drugs are hypotensive agents

48
Q

aberrant learning and role of medications

A

if you learn a motor program wrong the first time, it is a lot harder to learn the correct one w/ practice
w/out dopa, PD learn wrong first time compared to on dopa

49
Q

DBS

A

deep brain stim
sx implant of pacemaker
send electrical impulse to stim brain
implanted globus pallidus internen or subthlamic nuclei

50
Q

best candidates of DBS

A

good response to levodopa but have severe motor fluctuations that can’t be controlled w/ meds alone
interlate to meds
<70 yrs

51
Q

DBS contras

A

cog/psych problems
atypical PD, speech or swallowing progblems
frequent falls
decreased motor performance when on levadopa

52
Q

PD PT indications

A 
prevention
decreased fx mobility including gait dev
pain (shoulder: posture. back: rigid)
posture
balance
53
Q

falls occur in ___% of PWPD

A

68%

54
Q

exercise for neuroprotection

A

increase release of dopamine
increased number of dopamine receptors, more efficient w/ exercise
**exercise must start early

55
Q

Exercise is med

A 
improve cog fx
prevent depression
improve sleep quality
decrease constipation
decrease fatigue
improve motor performance 
improve drug efficiency
optimize dopaminergic system
56
Q

montreal cog assessment

A

MoCA
>/= 26/30 normal
use score to justify ST referal

57
Q

dystonia

A

abnormal sustained muscle contraction

document body part, trigger, how it interferes /w movement

58
Q

retropulsion

A

tendency to fall backwards

59
Q

dyskinesia

A

excessive movements, wristhing
disorder caused by meds
doc where, how if interferes w/ function

60
Q

shoulder pain and PD

A

common
related to postural changes
eval thoracic mobility, scapular mobility, SHR

61
Q

which measures of physical function and motor impairment best predict quality of life in PD?

A

freezing of gait

6MWT

62
Q

freezing of gait questionnaire

A

16 items eval

  1. gait of daily living
  2. freq/severity of FOG
  3. freq and festinating gait and rln to falls
  4. frequency and severity of alls
63
Q

best question to ask if you only have time for one questions (PD)

A

“do you feel your feet get glued to the floor while walking, making a turn or when trying to initiate walking?”

reliable for ID freezers

64
Q

ways to provoke freexing

A 
add turns
dual task
wake through doorway/narrow space
walk over lines in ground or change in floor type
add urgency
65
Q

gait analysis - PD

A 
trunk rotation
step length
arm swing
freezing
festination
shuffling
lack of WS
66
Q

10 m walk test

A

0.88m/s correctly predicted 70% of pts as community walkers

MDC value (95%)
comfortable gate speed = .18m/s
fast gate speed = 0.25 ms/
67
Q

FGA review

A

22/30 fall risk
15/30 fallers in PD pts

score 0-3, severe imp to normal amb

68
Q

mini best review

A

14 dynamic balance assessments
0 severe, 1 mod, 2 normal
<20/28 fall risk
if L and R, lower score used for total score

69
Q

4 square step

A

fall risk for PD

>9.68 seconds

70
Q

phases of PD intervention

A
  1. preclinical - neuroprotection
  2. early/mod - neurorepair
  3. late - adaption
71
Q

evidence based practice for PD

A

treatmill training
high intensity resistance training
cycle
aerobic exercise

72
Q

treadmill training and PD

A

increased gait speed, stride length after 1 session
feasible, safe, improve gait speed, stride length
improve QOL, UPDRS, long term carryover

73
Q

FE

A

forced exercise for PD
global improvements w/ high intensity aerobic exe cerise on tandem bike
improve bimanual coordination 4 weeks
decreased tremor, rigidity, bradykineasia

74
Q

high intensity resistance training PD

A

safe, muscle force production, pain, serum creatine kinase
hypertrophy, strength, improved speed w/ stair descent, improved 6MWT
decreased brady, improved QOL
improved rise from chair for CRE

75
Q

high intensity resistance training: focus on

A 
postural extension
hip ext, ab
knee ext
gastric/soleus
trunk ext

NeuroRehab (33 decks)

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