Neurological Movement Disorders

'Young' onset Parkinson's disease is classified as those under the age of

• < 40

• < 35

• < 30

• < 50

What are the two diagnostic criteria for Parkinson's disease?

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Answer explanation

Diagnosing Parkinson's

- Parkinsonism (rigidity, tremors, bradykinesia)

- Beneficial response to dopamine therapy

Parkinson's disease is primarily caused by degeneration of the substantia nigra. Symptoms start to develop once what % of the cells in the substantia nigra die off?

• 40%

• 25%

• 15%

• 60%

Braak stages 1 and 2 of Parkinson's involves autonomic and olfactory changes. What is the name for these two stages together?

• Prodromal

• Motor onset

Match the Braak stages of Parkinson's disease with their correct definitions.

• Autonomic and olfactory changes via olfactory bulb and vagus nerve

• Braak stages 3/4

• Emotional and cognitive disturbances

• Braak stages 1/2

• Sleep and motor disturbances

• Braak stages 5/6

Match the symptom group of Parkinson's with the correct stage (according to the Hoehn & Yahr Scale I-V).

• Complete invalidism, confined to chair, cannot stand or walk

• Stage 1

• Bilateral involvement, early postural changes, slow shuffling gait

• Stage 3

• Unilateral involvement, blank face, patient leaning to one side, affected arm semi-flexed, tremor

• Stage 5

• Pronounced gait disturbances, generalised disability, instability, tendency to fall

• Stage 2

• Significant disability, ambulation requires assistance

• Stage 4

Answer explanation

What standardised reporting scale could you use to assess a patient with Parkinson's disease?

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Unified Parkinson’s disease Rating Scale (UPDRS)

- Activities of daily living

- Self care, domestic tasks, communication

- Motor examination

- Cognitive

- Complications of treatment

Name two motor impairments, two emotional impairments, two cognitive impairments, and two autonomic impairments of Parkinson's disease.

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The motor impairments commonly observed in individuals with Parkinson's disease include:

- Bradykinesia: Slowness of movement and difficulty initiating voluntary movements.

- Rigidity: Increased muscle stiffness and resistance to passive movement.

- Tremor: Resting tremor, which typically appears as rhythmic shaking of the hands, fingers, or other body parts when at rest.

- Postural instability: Impaired balance and coordination, leading to difficulties with maintaining an upright posture.

- Akinesia: Difficulty initiating and executing voluntary movements. 

- Dystonia: Involuntary muscle contractions that cause twisting or repetitive movements, abnormal postures, or cramping.

- Dysphagia: Difficulty swallowing. Fluid entering the airway may result in chest infection/pneumonia.

- Hypophonia: Soft voice due to reduced range of motion of vocal cords.

- Difficulty commencing speech: Long gaps in initiating speech may lead to breakdown in communication. Difficulty stopping speech combined with other speech disorders may reduce speech intelligibility.

The emotional impairments associated with Parkinson's include:

- Depression: Symptoms of depression may include persistent sadness, loss of interest or pleasure, feelings of worthlessness, changes in appetite or sleep patterns, and difficulty concentrating.

- Anxiety: Anxiety disorders, including generalised anxiety disorder, social anxiety disorder, and panic disorder, can occur in individuals with Parkinson's disease. 

- Apathy: Apathy refers to a loss of motivation, interest, or enthusiasm for activities and can be a common emotional impairment in Parkinson's disease.

The cognitive impairments related to Parkinson's disease include:

- Executive dysfunction: Parkinson's disease can affect executive functions, which involve higher-level cognitive processes such as planning, decision-making, problem-solving, and multitasking.

- Memory problems: Memory impairments can occur in Parkinson's disease, particularly affecting the retrieval of information. Individuals may have difficulties with remembering recent events, appointments, or conversations. Long-term memory is generally less affected in the early stages of the disease.

- Attention and processing speed: Parkinson's disease can impact attention and processing speed, leading to reduced ability to concentrate, slower information processing, and decreased response speed.

- Visuospatial difficulties: Some individuals with Parkinson's disease may experience challenges with visuospatial abilities, which involve perceiving and interpreting visual information and spatial relationships. 

- Language and communication: Parkinson's disease can affect language and communication skills. This may include difficulties with word-finding, reduced verbal fluency, and changes in speech quality, such as softer or slurred speech.

The autonomic dysfunctions of Parkinson's disease include:

- Orthostatic hypotension: This condition refers to a drop in blood pressure upon standing up, leading to dizziness, lightheadedness, and sometimes fainting.

- Urinary problems: Parkinson's disease can cause urinary dysfunction, including urinary urgency, frequency, and difficulty initiating or stopping urination. 

- Constipation: Parkinson's disease often affects the digestive system, leading to slowed movement of food through the gastrointestinal tract and resulting in constipation.

- Excessive sweating: Some individuals with Parkinson's disease may experience excessive sweating, particularly during sleep. This can be attributed to autonomic dysfunction affecting sweat gland regulation.

- Sexual dysfunction: Parkinson's disease can cause sexual dysfunctions, such as decreased libido (loss of interest in sexual activity), erectile dysfunction in men, and reduced vaginal lubrication in women. 

Impaired thermoregulation: Individuals with Parkinson's disease may have difficulty regulating body temperature. They may experience fluctuations in body temperature, such as excessive sweating or difficulty staying warm.

Select which of the following medications for Parkinson's act as dopamine replacements. Select all that apply.

• Levodopa

• Dopamine agonists

• Carbidopa

Deep brain stimulation is a surgical management of Parkinson's disease useful for people experiences motor dysfunction.

• True

• False

Tags

NGSS.HS-ETS1-3