WK8 - Parkinson's Flashcards
Define Parkinson’s Disease?
A progressive neurological disorder characterised by a number of motor and non-motor features that can impact on function to variable degree
1st described by James Parkin - “Essay on the shaking Palsy” 1817
What is the pathophysiology of Parkinson’s Disease?
- reduction in neurotransmitter dopamine produced in Substantia Miagra (in Basal Ganglia)
- loss of dopamine within brain results in PD Sx
- Sx do not occur until there is greater than 80% loss of dopaminergic cells
What are the 5 pairs of nuclei situated deep in white matter of brain?
- Caudate nucleus
- Putamen
- Globus Pallidus
- Subthalamic Nucleus
- Substantia Niagra
What is the prevalence of PD?
- 2nd most common neurodegenerative disorder
- est. 7-10mil of people with PD
- 2014 - est. 69, 208 Australian’s with PD
What is the prevalence and cost growth of PD?
- no. of people with PD has grown by 14,500 since 2005
- est. by 2034 = 123,781 PD cases equating to avg. growth of 4% per annum over next 20y
- total economic cost per annum increased by 46% since 2005
What is the aetiology and risk factors of PD?
- ageing process
- 1.2-1.5x more common males
- family Hx
- environmental influences (rural, CO, bacteria/infection, toxin/pesticide/transition metal exposure (e.g. copper, iron, maganese)
- head trauma
- essential trauma
- REM sleep disorder
What are the primary motor features of PD?
- bradykinesia
- tremor
- rigidity
- postural instability
- freezing/akinesia
- postural deformity
What are the 2ndary motor features of PD?
- gait impairment
- re-emergence of primitive reflexes
- speech disorders
- slow blinking
- respiratory difficulty
What are the non-motor features of PD?
- autonomic dysfunction
- cognitive and neurobehavioural impairments
- sleep disorders
- sensory impairment
What is Bradykinesia?
Slowness of voluntary movements… difficulty with planning, initiating, executing movement and performing sequential/simultaneous tasks
- affects ADLs (walking/talking)
Ax
* patient performing rapid, repetitive, alternating mvoements of hand (i.e. finger taps, forearm pron/sup) and heel taps
Define tremor.
Unilat, occurring at frequency of 4-6Hz (4-6x/sec), usually prominent in distal part of extremity (hands)
- most prominent at rest - decreases with action and during sleep
*different from essential tremor where higher frequency (5-10hz), most prominent: action, symmetric, involves head/neck and voice.
Define muscle rigidity.
Increased resistance throughout passive ROM of limb (joint flex, ext, rot)
- velocity independent (unlike spasticity)
- may occur proximally (neck, shoulders, hips) and distally (wrists, ankle)
- may be associated with pain i.e. painful shoulder
Define postural instability.
Due to loss of postural reflexes, generally occurs late stages of PD after onset of other clinical features
Ax by pull test: patient pulled bwds or fwds by shoulders to Ax degree of retropulsion or propulsion respectively.
Define freezing.
Form of akinesia (loss of movement) - commonly affects legs during walking
* sudden/transient inability to move (typ. <10s)
*postural deformities
* abnorm. axial postures (e.g. scoliosis)
*striatal limb deformities - i.e. striatal toe characterised by toe flex/ext
Provide extra info on 2ndary motor Sx.
- re-emergence of primitive reflexes e.g. tonic neck reflexes
- speech disorders - monotonous, soft, breathy speech, difficulty finding words
- dysarthria, dysphagia - inability to initiate swallowing reflex
- decreased blink rate
- respiratory disturbances (restrictive or obstructive)
