W13 A: Intro to Parkinson’s Disease (PD)

Question 1

What is Parkinson’s disease ?

Answer 1

Parkinson’s Disease is :

A brain disorder associated w/ a loss of dopamine-producing nerve cells (neurons) deep inside the brain.

Question 2

______is the FASTEST GROWING neurological disease.

Answer 2

Parkinson’s Disease

Question 3

What part of the body does Parkinson’s disease affect?

Answer 3

• A complex neurological disorder that can affect almost every part of the body.
• Ranging from how you move to how you feel to how you think & process.

Question 4

What is Dopamine?

Answer 4

Dopamine:
-Is a neurotransmitter that helps regulate the body’s movement.

Question 5

What’s Dopamines role in Parkinson’s disease ?

Answer 5

-Less dopamine in the brain
= LESS control over
movement.

=LESS mobility in general

Question 6

Many treatments for PD work to REPLACE or ENHANCE lost _______.

Answer 6

-Many treatments for PD work to replace or enhance lost DOPAMINE.

Question 7

What are Lewy Bodies?

Answer 7

Lewy Bodies :
-Intracytoplasmic eosinophilia inclusions, often w/ halos, that are easily seen in pigmented neurons.

Contain polymerized alpha-synuclein (PD is a synucleinopathy)

Question 8

At the time of a Parkinson’s Diagnosis ___-___% of the SUBSTANTIA NIGRA is lost.

Answer 8

60-70%
Substantia nigra lost at time of diagnosis.

Question 9

PD is a multifactorial disease BOTH
___ & ___ factors playing a role).

Answer 9

PD is a multifactorial disease
(both genetic & environmental factors playing a role).

Question 10

What is the BIGGEST risk factor for PD?

Answer 10

• AGE
  is the biggest risk factor for PD.

Question 11

What is the median age of onset for PD?

Answer 11

Median age of onset:
60 y/o

Question 12

In regard to PD popullation
Incidence of the disease rises w/ age to ______
(per 100,000 person-yrs) in age groups between ____& __ y/o.

Answer 12

Median age of onset:
60 y/o

Incidence of the disease rises w/ age to 93.1
(per 100,000 person-yrs) in age groups between 70 & 79 y/o

Question 13

In regard to PD population /
Cross-cultural variations
, Higher prevalence occur /is reported in what geographical countries ?

Answer 13

Cross-cultural variations:
Higher prevalence reported in :

-Europe
-North America
-South America
-Compared w/ African, Asian, & Arabic countries

Question 14

• INCIDENCE

Question 15

In 2022 Parkinson’s Foundation-backed study revealed that nearly _________people are diagnosed w/ PD every year in the U.S.

Answer 15

In 2022 Parkinson’s Foundation-backed study revealed that :

[Nearly 90,000 people] are diagnosed w/ PD every year in the U.S.

Note:
(this represents a steep 50% increase from the previously rate of 60,000 diagnoses annually)

Question 16

Current PD Research:

Study:
“Incidence of Parkinson Disease in North America” found that:

-PD incidence estimates increase w/ age in the ____+ range.

-Primary risk factor for PD is ______-.

Answer 16

Current PD Research:

Study:
“Incidence of Parkinson Disease in North America” found that:

-PD incidence estimates increase w/ age in the 65+ range.

-Primary risk factor for PD is AGE.

Question 17

PD gender incidence estimates are HIGHER IN ____ as compared to ______ at ALL ages.

Answer 17

PD incidence estimates are HIGHER IN MALES as compared to females at ALL ages.

Question 18

The increase in the incidence of PD aligns w/ the growth of an _____ POPULATION.

Answer 18

The increase in the incidence of PD aligns w/ the growth of an AGING POPULATION.

Question 19

PD incidence rates are higher in certain geographic regions:
“_____ Belt”.

(parts of the N. eastern & midwestern U.S. previously regulated by industrial manufacturing), So. Cal, SE Texas, Central Pennsylvania & FL.

Answer 19

-PD incidence rates are higher in certain geographic regions:
“RUST BELT”.

(parts of the N. eastern & midwestern U.S. previously regulated by industrial manufacturing), So. Cal, SE Texas, Central Pennsylvania & FL.

Question 20

CARDINAL SYMPTOMS OF PD

Question 21

What are some MOTOR Cardinal Signs with PD?

Answer 21

• Tremor
  -Rigidity
  -Bradykinesia
  -Postural Instability

Question 22

What are some
NON-MOTOR Cardinal Signs with PD?

*Note there are many.

Answer 22

-Anosmia
(loss of sense of smell.)

-Constipation

-Rapid eye movement (REM)

-Sleep behavior disorder
-Depression
-Anxiety
-Orthostatic hypotension
-Daytime sleepiness
-Daytime Fatigue
-Exhaustion
-Pain
(often unilateral & in affected limb)

-Altered bladder function
-Erectile dysfunction
-Excessive saliva
-Integumentary changes
-Difficulty speaking & swallowing
-Apathy

-Cognitive problems (reduced concentration & attention, slowed thinking)
-Confusion (in some cases dementia)

Question 23

What is Parkinsonism?

Answer 23

Parkinsonism is an umbrella term that refers to brain conditions that cause :
-Slowed Movements
-Rigidity (stiffness)
-Tremors.

These conditions can happen for many reasons, including genetic mutations, reactions to medications and infections.

Question 24

What are some Parkinsonism related / causing conditions ?

Answer 24

-Drug-Induced Parkinsonism (DIP).

-Progressive Supranuclear Palsy
(PSP) (aka ALS).

-Multiple System Atrophy (MSA) (aka Shy-Drager Syndrome)

-Vascular Parkinsonism

-Dementia w/ Lewy Bodies
(DLB)

-Corticobasal Degeneration
(CBD)

Question 25

What is Secondary Parkinsonism?

Answer 25

Secondary parkinsonism is when symptoms similar to Parkinson disease are caused by:

-Certain medicines.
-Different nervous system disorder
-Or another illness.

Note:
Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease.

Question 26

What are some “Secondary Parkinsonism” related / causing conditions ?

Answer 26

-Post-encephalitic Parkinsonism.

-Toxic Parkinsonism

-Drug-Induced Parkinsonism (DIP)

-Parkinson Plus Syndromes

Question 27

TREATMENT PHARMACOLOGICAL
& MODALITIES

Question 28

PHARMACOLOGICAL
[MOTOR] :

What is the GOLD STANDARD pharmaceutical treatment for PD ?

Answer 28

Pharmacological Treatment :

LEVODOPA

-Gold-standard treatment for PD

-One of the FIRST Parkinson’s drugs & still the MAIN drug prescribed to treat PD.

Question 29

What is the role of LEVODOPA ?

Answer 29

Acts to help with :
- SLOWNESS
-STIFFNESS
-TREMOR

Question 33

TREATMENT

Deep Brain Stimulation (DBS)

-What symptom of PD is DBS used to treat ?

-What stage should it be used?

NOTE:
Approved to treat ADVANCED symptoms of PD in 02”

Answer 33

Used to treat TREMOR in people w/ PD
(approved by FDA in 97”)

For many years, DBS was held as a last resort treatment.
BUT,
-In the past few years, it has BEEN APPROVED FOR EARLIER STAGES OF PD.

-Procedure involves placing small electrodes into the regions of the brain that control movement & are impacted during the progression of Parkinson’s.

-The electrodes emit continuous electrical impulses (stimulation) from a device known as a stimulator, which is similar to a cardiac pacemaker & is implanted in the chest.

-In Parkinson’s, dopamine-producing neurons die
(thereby affecting the nerve cells in the brain responsible for body movement)

DBS DOES NOT affect dopamine levels in the brain (it compensates for the secondary effects of dopamine loss.

-Although its not a cure, it can lead to improvements in many motor symptoms (tremor, stiffness, slowness)

-As a result, this treatment may also make ADLs (getting in & out of chairs, walking, dressing, bathing) easier

Question 34

TREATMENT
Deep Brain Stimulation (DBS)

-Describe the process of how DBS is used ?

Answer 34

-Procedure involves placing small electrodes into the regions of the brain that control movement & are impacted during the progression of Parkinson’s.

-The electrodes emit continuous electrical impulses (stimulation) from a device known as a stimulator.

-A stimulator which is similar to a cardiac pacemaker & is implanted in the chest.

Question 35

TREATMENT
Deep Brain Stimulation (DBS)

-Describe the physiological affect of DBS is usage ?

-Does DBS affect Dopamine levels ?

Answer 35

-In Parkinson’s, dopamine-producing neurons die
(thereby affecting the nerve cells in the brain responsible for body movement)

DBS DOES NOT affect dopamine levels in the brain (it compensates for the secondary effects of dopamine loss.

Question 36

TREATMENT :
Deep Brain Stimulation (DBS)

What are the BENEFITS to DBS ?

Answer 36

Although its not a cure, it can lead to improvements in many motor symptoms Such as :
-Tremor
-Stiffness
-Slowness

-As a result, this treatment may also make ADLs easier.

-Getting in & out of chairs
-Walking
-Dressing
-Bathing

Question 37

TREATMENT :
Focused Ultrasound (FUS) Therapy

-What symptom of PD is FUS used to treat ?

-What stage should it be used?

Answer 37

An EARLY STAGE treatment.

FUS is a single procedure, non-invasive technology to manage :
-Tremor
-Dyskinesia

FDA approved
(also approved to treat tremor outside of the U.S.)

Question 38

TREATMENT :
Focused Ultrasound (FUS) Therapy

Describe the process of how FUS is used ?

Answer 38

Treats Parkinson’s symptoms through focused beams of ultrasonic energy that target specific areas deep in the brain
(interrupting circuits involved w/ tremor & dyskinesia)

Using a mechanism called ablation, the focused beams can disrupt targeted brain tissue to treat motor symptoms

Question 39

TREATMENT :
Focused Ultrasound (FUS) Therapy

-Describe the physiological affect of DBS is usage ?

Answer 39

Focused ultrasound allows for precise targeting of areas of the brain.
(there is NO damage to healthy tissue)

Other FUS mechanisms can temporarily disrupt the blood-brain barrier (BBB), allowing desired therapeutics access into the brain

Distraction of the BBB is also beneficial
(it enables undesirable substances to leave the brain more easily)

Question 40

PHARMACOLOGICAL
[NON-MOTOR] :

-What are some potential Non-motor symptoms that call for medications to be utilized with PD ?

Answer 40

-Antidepressants
-Constipation
-Drooling
-Fatigue
-Neurogenic
-Orthostatic Hypotension
-Overactive Bladder (OAB)
-Pain
-Parkinson’s-Related Dementia
-Parkinson’s Disease Psychosis