PD II Flashcards
Freezing of Gait Questionnaire
- 6-item questionnaire to be completed during “on” state
- Each item scored 0 (absence of sis) to 4 (most severe)
- Max score is 24
- Answers based on past week or overall presence of freezing that entire day
Levodopa-carbidopa and dyskinesia
Abnormal involuntary movements that usually occur at peak dose + increases in intensity with increased time on dose
Deep brain stimulation benefits
- Minimizes “off” time
- May be able to reduce medication dosage
FES benefits
- Improvements in UPDRS
- Maintained improvements in rigidity and bradykinesia 4 weeks after FES cessation
LSVT benefits
Improved TUG, UPDRS, gait speed
Anticholinergics brand names
- Artane
- Cogentin
Mini-BESTest
- 14 item test
- Each item scored 0 (severe impairment) to 2 (normal)
- Max score is 28
- Cut-off score: <23/28 consistent with increased risk of falling
Side effects of levadopa-carbidopa
- Nausea
- Drowsy
- OH
- Dyskinesia
- Hallucinations
Therapeutic windo of levadopa-carbidopa
- Over time, the duration target clinical response (therapeutic window) narrows/shortens
BESTest
- 36 item test
- Each item scored 0 (severe impairment) to 3 (normal)
- Max score is 108
- Cut-off score: <69% indicates risk of falling
Criteria for DBS
- Idiopathic PD
- Intact cognition
- Good response to dopamine
- Able to remain awake during surgery
- Able to be functional at baseline
Symptoms unresponsive to medications
- Postural instability
- Freezing
- Mental changes
- Autonomic nervous dysfunction
Proposed mechanism of FES
Improved reliance on feedforward processes - may be altering central motor control processes
Low dopamine
- Depression
- Apathy
- Anhedonia
- Anxiety
GPI vs Subthalamic Nucleus
No difference but may have a greater reduction of dosage with STN DBS
Dopamine agonists brand names
- Mirapex
- Requip
- Neupro
Amatadine
- Dopamine agonist and dopamine reuptake inhibitor
- Mainly utilized to treat dyskinesia
Limitations of DBS
- Infection
- Doesn’t effect postural instability
High intensity exercise
Improved gait speed/step/stride length + more normal corticomotor excitability based on shorted cortical silent period durations (CSP)
MAO type-B inhibitors
- Blocks breakdown of dopamine in the brain
MAO type-B inhibitors brand names
- Selegiline
- Resagiline
Imaging with FES
Shows that FES and medication utilize similar pathways
Levadopa
- Gold standard
- Precursor to dopamine that is able to cross blood brain barrier
On times and off times
On
- Medication is effectively controlling symptoms
Off
- Regular and predictable decline of symptom control between doses
COMT inhibitors
- Prevents peripheral degradation of levodopa
- May decrease “off” time or reduce levodopa dose necessary for clinical effect
High dopamine
- Euphoria
- Impulsve
- Risk taking behaviors
Sinemet and diet
Recommended to take 30 minutes before or 1 hour after meals
Dopamine agonists
- Directly stimulates dopamine agonists
- Started as initial therapy or adjunct to levodopa-carbidopa
- Not as effective as Sinemet but provides relief with longer half-life
Anticholinergics
- Reduces over activity of acetylcholine - thus inhibiting dopamine rey-take in the striatum
- Mainly used for tremors and rigidity
Target sites of DBS
- Thalamus: Mainly reducing tremors
- GPI/Subthalamic Nucleus: tremor, rigidity, bradyknesia, dyskinesia
Carbidopa
DOPA decarboxylase inhibitor
- Prevents levadopa from converting to dopamine in the periphery
Parkinson’s Disease Questionnaire-39
- 39-item self-report questionnaire
- Each item is scored 0 (never) to 4 (always)
- 8 dimensions: mobility, ADLs, emotional well-being, stigma, cognition, communication, bodily discomfort
- Answers based on past month
COMT inhibitors brand names
- Comtan
- Tasmar
Amatadine brand names
- Symmetrel
- Kemadrin
