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Year 2: Neuromuscular II > Test 2: Parkinson's > Flashcards

Test 2: Parkinson's Flashcards

1
Q

how many people are affected by PD every year

A

1 million americans

10 million globally

2% people over 65

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2
Q

average onset age of PD

A

between 50 and 60

can have young onset (21-50) or Juvenile (<21) (10% of cases)

more likely men

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3
Q

etiology of PD

A

disturbance if dopamine (DA) system in basal ganglia

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4
Q

types of PD

A

idiopathic (78%)
- Postural instability gait disorder subtype
-tremor dominant subtype

genetic

secondary parkinsonisms

atypical parkinsonisms

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5
Q

characteristics of postural instability gait disturbance type PD

A

worse prognosis

more bradykinesia

higher prevalence of non-motor symptoms

higher likelihood of dementia

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6
Q

characteristics of tremor dominant parkinsons

A

better prognosis

less difficulty with bradykinesia and postural instability

lower incidence of non-motor S&S

lower risk of developing dementia

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7
Q

genetic markers for PD

A

10% cases = genetic

some families share gene mutations: SNCA, PARK1, PINK1, LRRK2, DJ-1, glucocerebrosidase

2 types of gene mutations:
- those that cause PD
- those that increase risk of developing

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8
Q

what is postencephalitic PD

A

caused by strain of influenza between 1917 and 1926

no recent outbreaks; if you see these pts they will be 90-100

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9
Q

what is toxic parkinsonism

A

exposed to pesticides/industrial chemicals

manganese = most common; miners often exposed

synthetic heroin with chemical MPTP

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10
Q

what is drug induced parkinsonism

A

drugs that interfere with DA systems

neuroepileptic drugs, antidepressants, and some antihypertensives

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11
Q

types of PD plus syndromes

A

progressive supranuclear palsy

multiple systems atrophy

cortical bassal ganglionic degeneration

lewy body dementia

normal pressure hydrocephalus

creutzfeldt-jakob disease

wilsons disease

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12
Q

parts of basal ganglia

A

caudate nucleus
putamen
globus pallidus
subthalamic nucleus
substantia nigra

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13
Q

pathophysiology of PD

A

degeneration of dopaminergic neurons

produce less dopamine (DA)

can get alpha synuclein cytoplas inclusions (Lewy bodies) as disease progresses

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14
Q

describe how the direct loop works

A

excitation of putamen to globus pallidus

GP to ventral lateral nucleus of thalamus

VL to SMA

result = voluntary motor movement and positive feedback loop

need DA from substantia nigra to help with activation

Inhibition of the direct pathway and functioning of the indirect (double inhibition)

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15
Q

general categories of symptoms of PD

A

cardinal motor

other motor S&S

non-motor symptoms

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16
Q

cardinal motor S&S

A

bradykinesia
tremor - resting
postural instability - falls are likely
rigidity

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17
Q

describe the rigidity that comes with PD

A

uniform in agonist and antagonist

cogwheel (jerky) or leadpipe (constant) resistant to passive movement

constant regardless of task or speed of movement

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18
Q

other motor S&S of PD (mm performance, motor function, gait, dysphagia, etc)

A

mm performance
- motor recruitment delayed

motor function
- difficulty with speed/accuracy
- difficult with dual tasking
- difficulty with starting and stopping motion

gait
- 25% = this is initial symptom
-flexed posture
- bradykinesia
- decreased arm swing
- freezing possible

dysphagia
- 95% will have swallowing difficulty

hypokinetic dysarthria

19
Q

clusters of non-motor S&S of PD

A
  1. rapid eye movement sleep behavior disorders
  2. cognition related
  3. mood related
  4. sensory and disautonomia
20
Q

characteristics of rapid eye movement sleep behavior disorders

A

frequent nightmares

dream enacting behaviors

insomnia

21
Q

cognition related symptoms for PD

A

memory complaints

cognitive fatigue

inattention

excessive day- timeless sleepiness

mild cognitive impairments

22
Q

mood related symptoms related to PD

A

anehodonia
- lack of interest, enjoyment, or pleasure in things that generally bring joy

apathy
-flat affect

mood disturbance
- depression
- subclinical depression
- suicidal ideation
- anxiety

23
Q

sensory and dysautonomia S&S associated with PD

A

loss of taste

loss of smell (often early sign of PD; will happen in 100% pts)

visual perception disturbances

chest pain

unexplained pain

paresthesias

hyperhydrosis (excessive sweating)

GI disorders (urinary incont/constipation)

orthostatic hypotension

24
Q

describe the movement disorder society (MDS) clinical diagnostic criteria for PD

A
  1. Bradykinesia in combo with at least resting tremor and/or rigidity
  2. absence of absolute exclusion criteria, at least 2 supportive criteria (i.e. responding well to domaminergic agents) and no red flags
25
medical management of PD
pharmacology nutritional management - high protein diets can block effectiveness of levodopa - need high calorie, low protein diet - some need PEG tubes deep brain stimulation - for tremor usually - can impact gait, on/off symptosm - electrodes typically in globus pallidus internus or subthalamic nucleus referrals to other specialties
26
pharmacology management of PD
goal = want to increase/keep dopamine carbidopa/levodopa = replaces lost DA dopamine agonists = stimulate DA receptors in basal ganglia COMT inhibitors = block breakdown of levodopa MAO-B inhibitors = block breakdown of levodopa anticholinergics = reduce excessive ACh influence caused by decrease of DA
27
what specific systems should be screened for PD pts in PT
cognition -Mini Best - mini mental - MOCA psychosocial function - depression screen -QOL sensory MSK ANS neuromuscular
28
common outcome measures for PD
Hoehn and Yahr United Parkinson's Disease Rating Scale PD EDGE
29
describe the staging of PD with UPDRS as well as what is being measured with the scale
gold standard for determining disease severity often done by neurologist time consuming score 0-4 on each item, higher numbers are worse measures: - mentation, behavior, and mood (4 items) - ADLs (13 items) - motor scale (14 items) - additional section for other symptoms (11 items) on things like on/off periods, hypotension, etc
30
what does the UDRS section 1 (mentation, behavior, and mood) include
intellectual impairment thought disorder depression motivation/initiative
31
UDRS section 2 (ADLs) looks at what
speech salivation swallowing handwriting cutting food/utensil use dressing hygiene turning in bed falling freezing walking tremor sensory complaints
32
UDRS section 3 (motor exam) looks at what
speech facial expression tremor at rest action or posture tremor rigidity finger taps hand movement rapid alternating movement leg agility rising from chair posture gait postural instability brady/hypo kinesia
33
recommended measures for body structure and function for PD edge
MDS- UPDRS revision part 3 MDS UPDRS part 1 montreal cognitive assessment
34
recommended measures for activity section for PD edge
6 MWT 10 MWT MINI best MDS-UPDRS part 2 FGA 5x STS 9 hole peg test
35
recommended measures for participation with PD edge
PDQ- 8 PDQ- 39
36
PD specific measures tests
parkinsons datigue scale (PFS-16) UPDRS parkinsons disease questionnaire 39 (PDQ-39) parkinsons disease questionnaire 8 (PDQ-8) new freezing gait questionnaire (NFOG-Q)
37
highly recommended interventions for PD
aerobic ex resistance training balance external cueing community based ex gait training task specific training behavior change approach integrated care
38
can pts with PD remediate function? How?
yes can use neuroplasticity - use it or lose it - repetition matters - use it improve it - intensity matters - high/big - salience matters improving function/brain response... NOT changing disease itself high intensity/high reps for PD; don't have as much fatigue and stress response as other neurodegenerative diseases
39
what to keep in mind when treating PD MSK probs
treat the MSK problems but keep in mind the neurologic condition i.e. frozen shoulder is common, but this is often due to the decreased movement and overall movement/gait pattern associated with PD
40
cueing to keep in mind with PD
visual cues help auditory cues help too many cues are not helpful weight shifts can help get out of freezing
41
PT POC for PD pts
remediation og function is possible treatment of MSK is possible still ultimately progressive may consider skilled maintenance between remediation episodes medication timing may matter
42
where will you typically see PD pts (what setting of PT)
typically OP PT but can see in any setting
43

Year 2: Neuromuscular II (18 decks)

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