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)
Provide more info on the non-motor feature affects on the body.
- autonomic dysfunction
- orthostatic hypo, sweating dysfunction (hypo/er-drosis), thermoregulation / GI issues.
- dementia, depression, apathy, cravings/binge eating, halluncinations, psychosis
- REM sleep disorder (approx. 1/3 patients), insomnia
- sensory abnormalities - oral pain, olfactory dysfunction, paraesthesia (pins/needles), genital pain
How to Dx PD?
No definitive test for PD, typ. based on combo (2-4) of cardinal motor features
Dx difficult in early stages where Sx may overlap with other disorders
What is the Tx for PD?
- Pharmacological
* Levodopa - gold standard/primary Tx
* Dopamine agonist - mild PD, younger onset
Periphera and central SE: GI distress, confusion, hallucinations, insomnia, dyskinesia (levodop induced)
- Surgical Tx - more common due to advances in brain imaging techniques
* e.g. deep brain simulation of subthalmic nucleus improves motor function and reduces dyskenesia and motor fluctuations
What are the 2 main purposes of PA in PD management?
- delay progression
- manage/improve Sx
This area of research is understudied and hampered by small, heterogeneous sampes
What is a beneficial Ex regimen for PD?
- CV Ex
- RT
- balance
Still lack of evidence supporting Ex sequence
Aim to improve gait speed, strength, balance, QoL which med Tx do not fully address.
What is the recommended CV Ex?
Mod and High intensity aerobic Ex on treadmill/cycling - up to 30mins/session
- limited RCTs confirming long-term benefits of CV training to PD patients - no proven endurance on specific PD features.
- Short-term studies - 12wks progressive treadmill walking increases PD rating scale, 6MWT, peak ambulatory capacity
- endurance training (high levels) improves VO2max and gait in mod-mildly affected patients.
What does research say on resistance exercises?
Strong evidence - PD affects muscle strength
* LB RT (avg. 16wks) - improves leg strength but not gait speed or balance
* MIRT 2-3x/wk over 8-10wks can increase strength, balance, motor Sx in mild-mod PD patients
What does research say on balance training/Tai Chi for PD patients?
For postural instability and balance impairments to reduce frequency of falls and injuries
- Balance improves Berg Balance Scale, Activities based Balance Scale, postural transfer test, no. of falls
- combined balance and RT improves PD patient balance scores than balance training alone
- Tai Chi - decreases fall, effects maintained 3M after intervention
- more evidence needed
What is the relationship between dancing and PD?
Promotes:
* aerobic fitness
* LB strength and flexbility/mobility
* balance
* gait
* movement initiation
* postural stability
What are the advantages of dancing for people with PD?
- music rhythm can assist movement cueing/initiation
- other dancers help with cueing
- dancing with partner assists cueing, balance and modelling movement
- social setting and enjoyable activity - improve motivation and adherence
- certain dances have certain benefits - ballet (postural stability) and zumba (aerobic fitness)
- cognitive engagemetn required to learn different dances/movement strategies
What are some important Ex prescription considerations for people with PD?
- inform GP /request med advice at start of Ex program
- PD patients have high CV risk - screen for Sx
- begin 45-60mins after med
- if balance poor - use ergometer with seat or treadmill with safety harness
- HR responses may vary greatly on daily basis - use other indicators intensity
- poor temp regulation
- graded Ex test to determine med effects on performance
What are some recommendations for future Ex interventions?
- evaluate effective ways of promoting activity in PD patients
- less emphasis on highly supervised programs, expensive equipment and more self-managed Ex
- longer duration studies
- investigate more severe PD
- investigate elements that make up an optimal Ex program
- look at physical Ex effects but ALSO effects on cognitive functions, depression, social connectedness and well-being
