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100

differential diagnosis:

- not secondary to any known cause

- shows a sustained +response to dopaminergic medicine

-Lewy bodies are only seen in basal ganglia

idiopathic parkinsons

100

differential diagnosis related disorders:

  • Symmetrical onset, incontinence and orthostatic hypotension are early signs

  • Tremor is rare, dysmetric, UMN and LMN signs, vocal cord paresis is common, Shy-Drager syndrome, striatonigral degeneration, olivopontocerebellar atrophy.

  • Does NOT respond to dopaminergic meds

multiple sclerosis

100

what happens when there is not sufficient dopamine?

increased inhibition of the thalamus leads to movement deficits

100

describe rigidity including the different types (cogwheel, lead pipe, dystonia)

  • Made worse with active movement, mental concentration, emotional tension

  • Increase in muscle tone


    • Cogwheel rigidity: combo of rigidity and tremor results in jerky response to PROM

    • Lead Pipe rigidity: sustained resistance to PROM throughout range

    • Dystonia: fixed positioning of hands and feet (twisting and/or repetitive) 

100

pre-clinical parkinson symptoms

  • Olfactory loss****

  • Autonomic dysfunction


    • sweating***

    • Heart rate changes


      • May have blunted response to exercise without beta blockers

    • Orthostatic hypotension

    • Syncope

    • Constipation

  • Sleep behavior disorder


    • Violent dreams

    • Striking out a spouse

  • Depression

  • Decreased shoulder ROM***, shoulder pain

  • Low back pain and stiffness

  • If you have a patient that is slowly losing ROM for no reason then possibly PD

200

differential diagnosis: parkinsons

- subcortical white matter infarct

- usually affects lower body only

- 

vascular parkinsons

200

differential diagnosis related disorders:

  • Asymmetrical onset with rigidity and dystonia of involved arm. 

  • Cortical apraxia, sensory loss, reflex myoclonus, and speech/language disorders, alien hand

  • It is progressive and usually people die within 10 yrs

  • Does NOT respond to dopaminergic meds

corticobasal degeneration

200

what happens when you excite the direct pathway?

excitation of this pathway causes thalamic excitation which facilitates movement

200

describe akinesia including the difference between bradykinesia and hypokinesia

  • Freezing of gait and difficulty initiating movement

  • Fall risk and instability occur because movements are too small or slow

  • Bradykinesia: 


    • Decreased movement velocity, slowness of movement, and increased time for ADLs, decreased gait speed

  • Hypokinesia


    • Decreased mvmt amplitude, shuffling gait, and small reaches

200

how does levadopa affect a parkinsons pt

Very good symptom control early in disease, but requires increasing doses with increasing side effects over time

300

differential diagnosis: parkinsons

- meds-> antipsychotics, antidepressants or reglan

- environmental toxins

- MPTP

drug or toxin induced parkinsons

300

differential diagnosis related disorders:

  • Development of dementia within less than one year of the development of motor symptoms

  • Aggregations of alpha-synuclein protein that develop within nerve cells. 

  • Lewy bodies are seen only in basal ganglia and cortex

  • PD meds cause confusion, psychosis, and frightening hallucinations

Lewy body disease

300

what happens when you excite an indirect pathway

excitation of this pathway inhibits the thalamus, resulting in inhibition of movement

300

what are some gait disorders seen in parkinson patients

Decreased arm swing, decreased step length, shuffling, decreased speed, festinating gait, retropulsion, freezing of gait especially when walking, turns, stressed, floor changes, and through narrow spaces

300

how does parcopa affect parkinsons pts

  • Dissolves under tongue for immediate release

  • Used for patients in advanced stages of disease

400

differential diagnosis: parkinsons

- resulting from chronic head trauma, accompanied by dementia and cerebellar defects

post-traumatic parkinsons

400

differential diagnosis related disorders:

  • Affects lower body, classic PD gait presentation, incontinence and dementia, NO tremor, retropulsion with STS

  • Dx made via imaging or LP

  • Tx: VP shunt

normal pressure hydrocephalus

400

What does TRAP stand for 

tremor

rigidity

akinesia

postural inability 

400

motor signs/symptoms of parkinsons

  • Gait Disorder

  • Freezing

  • Flexed Posture

  • Dyskinesias (med side effect)

  • Dysphagia

  • Sialorrhea (drooling)

  • Dysarthria, Microphonia

  • Dystonia

  • Micrographia

  • Fatigue

  • Hypomimia (Mask Like Facies) - facial nerve dysfunction

400

got tired

sorry

500

differential diagnosis: related disorders

  • Often confused with idiopathic PD. 

  • Early freezing and falling, symmetrical axial onset, impaired vertical gaze, dysphagia, dysarthria, emotional lability.

  • Meds for PD may work at first but then lose their efficacy→poor prognosis 

progressive supra-nuclear palsy

500

Where are dopaminergic neurons located? What does dopamine modulate?

substantia nigra pars compacta

activity at the striatum, disinhibiting the thalamus, and facilitating voluntary movement

500

describe parkinson tremor

  • Resting tremor and tends to have pill rolling nature

  • Can affect hand, foot, occasionally jaw and some report internal tremor

  • Worsens with stress and fatigue

  • 4-6Hz

500

nonmotor signs/symptoms of parkinsons

  • Cognitive Changes

  • Mood disorders (depression, anxiety)

  • Olfactory dysfunction

  • Constipation

  • Urinary urgency/incontinence

  • Sleep Disturbance

  • Hyperhidrosis

  • Seborrhea (oily skin)

  • Sexual Dysfunction

500

:)

:)