What is the primary neurotransmitter involved in Parkinson's Disease?
Dopamine.
Though the balance of dopamine with acetylcholine in the CNS seems to be a key factor... Thanks Larry.
What are the cardinal signs of Parkinson's Disease?
T-tremor
R-rigidity
A-akinesia (bradykinesia)
P-postural instability
(come on, admit it, you were thinking it)
What is the primary Parkinson's Disease impairment measure?
Describe it.
Hoen and Yahr
A 5 point scale in .5 increments ranging from minimal impairment at 1 to confined to bed/WC at 5.
What is the primary medical intervention for Parkinsons?
Carbidopa/Levodopa
What is the primary surgical intervention for Parkinsons?
Deep Brain Stimulation
How does PT intervention approach Parkinson's patients as the disease progresses?
Initially restoration, then compensation in later stages.
Are men or women more likely to get Parkinsons?
What is the most likely age?
Where is it most prevalent?
Neither. It is an equal opportunity offender.
65+
Industrialized countries.
Briefly give a description of Parkinson's Disease.
A chronic, progressive, neurological disease characterized by motor signs like TRAP, and non-motor signs such as frontal lob functions. (JEMM)
It is primarily attributed to degeneration of the dopamine producing substantia nigra neurons and a reduction of
What is the most common form of Parkinson's Disease?
Idiopathic - the classic one we study the most...
The direct and indirect pathways are synaptic connections between the motor cortex and basal ganglia that help coordinate movement.
The direct pathway ________ motor cortex activity, and in the absence of dopamine, is _________.
The indirect pathway _____
stimulates, decreased
inhibits, increased
What are the dopamine receptors most inhibited by Parkinson's disease?
D1, D2, D3, or D4?
D1 and D2
What is monoamine oxidase?
What is its relevance to Parkinson's disease?
An enzyme that breaks down monoamines neurotransmitters, of which dopamine is one.
MAO inhibitors may be used to increase dopamine in the synaptic cleft.
(pretend the pictures says dopamine instead of serotonin)
What is JEMM?
What is the relevance to Parkinsons Disease?
What is another very common non-motor impairment of Parkinson's disease?
Some of these non-motor impairments are due to what?
Judgement
Emotion
Memory
Motivation
Parkinsons affects more than just the basal ganglia, it also affects frontal lobe functions like JEMM.
#1 is sleep abnormalities and fatigue, as well as depression and anxiety. There are also sensory impairments burning
What is the considered the most disabling symptom of Parkinsons?
What symptoms indicates advanced stages of Parkinsons?
What symptom makes a Parkinsons patient an increased fall risk? How much more likely is a Parkinson's patient to fall that other age re
The bradykinesia (akinesia) motor impairment.
Postural instability.
Probably multiple, but the one listed is postural instability.
5x more likely.
What is the UK Brain Bank Criteria to diagnose PD? (description)
What symptom/criteria did Swank say was "often a key determinant" in diagnosing Parkinsons that is part of the UK Brain Bank Criteria?
A menu of symptoms grouped into 3 criteria. If all three criteria are met then the official diagnosis is Parkinsons.
Excellent response to levodopa.
Levodopa is the go-to drug for treating Parkinsons. It does however have some (short-term, long-term) drawbacks. What are they?
Long-term (3-5 years)
Drawbacks include the patient losing sensitivity to the drug and having symptoms worsen. In the long-term, as D1-D2 receptors desensitize to levodopa, the excess dopamine that has built up in the CNS can start creating secondary issu
There are three other conditions related to the classic idiopathic Parkinson's Disease. What are they, and give a brief description.
Parkinsonism Syndromes - more rapid and aggressive onset, and more symmetrical symptoms.
Secondary Parkinsonism - acquiring Parkinson's disease from a known secondary agent, like drugs, toxins, infection, or something else that disrupts the substantia nig
What is progressive supranuclear palsy?
A Parkinsons plus syndrome, that represents about 5% (3rd most common) of prevalence.
What is multiple system atrophy?
A Parkinsons plus syndrome, that represents about 10% (2nd most common) of prevalence.
What is Dementia with Lewy Bodies?
What is a Lewy Body anyway?
A Parkinson's plus syndrome that is like Parkinson's and Alzheimer's combined. (major suckfest, and not to be confused with normal pressure hydrocephalus, a previous test questions with that exact same description...)
A Lewy body is a protein aggregate th
How effective is imaging in the diagnosis of Parkinsons?
What imaging would you use?
Not very, though MRI, PET, and SPECT are probably your most helpful. Cannot diagnose from imaging alone.
I'll say it again, _____________ is the cornerstone, primary, and go-to medical treatment of Parkinsons.
Levadopa.
Used to both diagnose and treat Parkinsons.
What is the basic mechanism by which Levadopa works?
What receptor does it work on?
Is it effective?
What are some of the negative side effects of Levadopa?
Levadopa is a drug that mimicks L-Dopa, a catecholamine precursor that is able to enter the blood brain barrier where as full-blown dopamine can not. Enzymes in the brain can then change it to Dopamine, restoring neurotransmitter levels without needing th
A dopamine agonist, unlike Levadopa, works how?
It is a manufactured compound that activates dopamine receptors but is not a naturally occurring molecule.
Also, it activates D2 receptors, not the D1 receptors like Levadopa.
What is the most effective surgical treatment of Parkinson's Disease? Describe it.
What are it's limitations?
Deep Brain Stimulation. Electrodes are placed in the deficit areas of the brain to stimulate them (think pace-maker for the brain), essentially bypassing the need for dopamine. It does greatly assist with gross motor skills.
Deep Brain Stimulation can onl
Parkinson's patients are a fall risk. What can we do about it?
By correcting their posture, we improve their inherent balance and help prevent falls.
What can we do about the primary impairment of Parkinson's Disease?
Not much.
But we can address posture, and overall reduced physical activity which causes deconditioning and increases overall disability.