PD

Question 1

What is PD?

Answer 1

It is a chronic progressive neuro degenerative disease where there is a lack of dopamine created in the substantia nigra in the basal ganglia.

PD is characterised by rigidity, bradykinesia and a resting tremor.

Question 2

Role of the Basal Ganglia (PD)?

Answer 2

• To regulate planning, initiation and termination of movement
• Regulate muscle tone
• Control subconscious contractions of skeletal muscles
• Involves the thalamus and cerebral cortex with DIRECT (dopamine excites the direct) and INDIRECT (dopamine inhibits the indirect) pathways. A lack of dopamine to both pathways creates an overall lack of movement.

Question 3

What is Bradykinesia (PD)?

Answer 3

A slowness of movement - slower initiation and reduction of speed.

Question 4

What is Resting Tremor (PD)?

Answer 4

Resting tremor (pill rolling) occurs when the muscle is relaxed. Arms, hands and legs can shake when they are at rest.

Tremor is inhibited during movement.

Question 5

What is Rigidity (PD)?

Answer 5

Stiff or inflexible muscles

Resistance to PROM in both directions (not velocity dependent like spasticity)

Lead pipe rigidity or cog wheel rigidity

Question 6

Secondary symptoms of PD?

Answer 6

• Difficulty initiating and terminating movement
• Dysphagia (problems swallowing)
• Flexed posture (neck, thoracic, hips, knees)
• Shuffling/festinating gait
• ‘Freezing’ when walking
• Poor balance
• Ataxia
• Loss of facial expressions
• Monotone speech

Question 7

Scale to measure severity of PD?

Answer 7

Hoehn and Yahr Scale

Stage 0 (no signs of disease), 1, 1.5, 2, 2.5, 3, 4, 5 (needs wheelchair, bed ridden)

Question 8

Medical Management of PD?

Answer 8

Dopamine replacement - Levadopa - ALONG WITH Madopar/Sinemet (dopamine cannot cross the blood-brain barrier so these help to facilitate crossing to the brain) - Effects reduce over time.

Surgery - deep brain stimulation, thalamotomy