Parkinson 1 Flashcards
• Idiopathic PD
• Parkinson’s plus
– Multiple system atrophy (aka Shy-Drager syndrome)
– Progressive supranuclear palsy
– Lewy body disease
• Parkinsonism
– Postencephalitic,
– Drug-induced, toxin-induced
– Vascular
• Idiopathic PD
• Parkinson’s plus
– Multiple system atrophy (aka Shy-Drager syndrome)
– Progressive supranuclear palsy
– Lewy body disease
• Parkinsonism
– Postencephalitic,
– Drug-induced, toxin-induced
– Vascular
Parkinson’s disease, paralysis agitans, shaking palsy
• Idiopathic, • Degenerative • CNS disorder • with 4 characteristic features 1. \_\_\_\_\_\_\_\_\_\_\_\_ 2. \_\_\_\_\_\_\_\_\_\_\_\_ 3. \_\_\_\_\_\_\_\_ 4. \_\_\_\_\_\_\_
Parkinson’s disease, paralysis agitans, shaking palsy
• Idiopathic, • Degenerative • CNS disorder • with 4 characteristic features 1. Slowness & poverty of movement 2. Muscular rigidity 3. Resting tremor 4. Postural instability
• POSTURAL INSTABILITY :
late feature
• Must exclude drug-induced disease
• Definitive diagnosis on autopsy
Based on clinical signs, physical examination, history
• 2 of the 3 cardinal signs must be present
– Tremor : resting tremor (disappears with movement), increases with stress
– Rigidity : “ratchet”-like stiffness (cogwheel rigidity); also leadpipe rigidity
– Akinesia /bradykinesia : subjective sense of weakness, loss of dexterity, difficulty using kitchen tools, loss of facial expression, reduced blinking, difficulty getting out of bed/chair, difficulty turning while walking.
Based on clinical signs, physical examination, history
• 2 of the 3 cardinal signs must be present
– Tremor : resting tremor (disappears with movement), increases with stress
– Rigidity : “ratchet”-like stiffness (cogwheel rigidity); also leadpipe rigidity
– Akinesia /bradykinesia : subjective sense of weakness, loss of dexterity, difficulty using kitchen tools, loss of facial expression, reduced blinking, difficulty getting out of bed/chair, difficulty turning while walking.
Diagnosis
• Non-motor symptoms at presentation
______________________
Diagnosis • Non-motor symptoms at presentation – Pain – Urinary frequency – Anxiety, depression – Constipation – Hyposmia (olfactory dysfunction)
Clinical presentation of PD
Micrgraphia Hypomimia Hypophonia Hyperhidrosis Decrease blink rate Orthostatic hypotension Psychosis Sleep disturbance Confusion Dementia Festination
Idiopathic PD – features at initial presentation
- Asymmetric
- Positive response to levodopa or apomorphine
- Postural instability (& falls) - not present
- Less rapid progression (rapid = H&Y 3 in 3 years)
- Autonomic dysfunction – not present
- Neuroimaging - ??
- Impaired olfaction (?)
Morbidity
- Unable to perform ADLs
- Choking
- Pneumonia
- Falls
Pathology
• Loss of dopaminergic neurons in the substantia nigra
– About 80% loss –> clinical symptoms
• Age-related loss of neurons?
• Environmental toxin / insults?
– MPTP-MPP+
– Pesticides, herbicides
• Genetics?
– Predisposition to toxins / insults
– Genetic abnormalities
Stage One
– Signs and symptoms on one side only
– Symptoms mild
– Symptoms inconvenient but not disabling
– Usually presents with tremor of one limb
– Friends have noticed changes in posture, locomotion and facial expression
Stage One
– Signs and symptoms on one side only
– Symptoms mild
– Symptoms inconvenient but not disabling
– Usually presents with tremor of one limb
– Friends have noticed changes in posture, locomotion and facial expression
• Stage Two
– Symptoms are bilateral
– Minimal disability, able to walk
– Posture and gait affected
• Stage Two
– Symptoms are bilateral
– Minimal disability, able to walk
– Posture and gait affected
Stage Three
– Significant slowing of body movements
– Early impairment of equilibrium on walking or standing – Generalized dysfunction that is moderately severe
Stage Three
– Significant slowing of body movements
– Early impairment of equilibrium on walking or standing – Generalized dysfunction that is moderately severe
Stage four – Severe symptoms – Can still walk to a limited extent – Rigidity and bradykinesia – No longer able to live alone – Tremor may be less than earlier stages
Stage four – Severe symptoms – Can still walk to a limited extent – Rigidity and bradykinesia – No longer able to live alone – Tremor may be less than earlier stages
Stage Five – Cachectic stage – Invalidism complete – Cannot stand or walk – Requires constant nursing care
Stage Five – Cachectic stage – Invalidism complete – Cannot stand or walk – Requires constant nursing care
“Measuring” PD - Hoehn and Yahr
• Assesses mobility
• If on treatment, should be assessed when the person is in the “ON” and also in the “OFF” state
“Measuring” PD - Hoehn and Yahr
• Assesses mobility
• If on treatment, should be assessed when the person is in the “ON” and also in the “OFF” state
“Measuring” PD – Unified Parkinson’s Disease Rating Scale
(1) Mentation, Behaviour, Mood – E.g. intellectual impairment, depression
(2) Activities of Daily Living – E.g. speech, salivation, swallowing, dressing, hygiene, walking
(3) Motor Examination – E.g. facial expression, tremor at rest, gait
(4) Complications of Therapy – E.g. dyskinesias, clinical fluctuations
“Measuring” PD – Unified Parkinson’s Disease Rating Scale
(1) Mentation, Behaviour, Mood – E.g. intellectual impairment, depression
(2) Activities of Daily Living – E.g. speech, salivation, swallowing, dressing, hygiene, walking
(3) Motor Examination – E.g. facial expression, tremor at rest, gait
(4) Complications of Therapy – E.g. dyskinesias, clinical fluctuations
