Parkinson Disease

parkinson disease definition

chronic progressive neurodegenerative disorder

depletion of dopamine from substantia nigra in basal ganglia

loss of inhibitory dopamine results in excessive excitatory output from cholinergic system of BG

as disease progresses, lewy bodies accumulate

parkinson disease etiology

infection, artherosclerosis, idiopathic, toxin or drug induced

parkinsonism

S/S like parkinson but without official diagnosis

signs and symptoms of parkinson mnemonic

TRAP

signs and symptoms appear…

after 40% damage

T stands for

resting tremor

pill rolling presentation

worsens with emotional stress

occurs first in one hand

R stands for

rigidity

affects agonist and antagonist

in early stages often asymmetrical and proximal muscles (shoulders, neck)

progresses to involve muscles of face and extremities

cogwheel rigidity

jerky ratchet like resistance to PROM

occurs when tremors exist with rigidity

lead pipe rigidity

sustained resistance to PROM with no fluctuations

inspect voluntary repetitive movements to determine active limitations

A stands for

akinesia and bradykinesia

akinesia occurs later in PD

freezing episodes (fixed posture)

difficulty with sit to stand transfer

P stands for

postural instability

thoracic kyphosis, head forward posture

decreased trunk rotation and arm swing

leaning forward or backward when upright

other signs/symptoms

festinating gait

freezing of gait

hypophonia

dysphagia, dysarthria

orthostatic hypotension

decreased ROM

akathisia

autonomic changes

reduced endurance

decreased thoracic expansion

festinating gait

progressive increase in speed with short stride

unable to stop on command

general lack of extension

freezing of gait

sudden abrupt inability to initiate any movement

cognitive load and music helps

doorways or turns lead to freezing episodes

hypophonia

decreased volume of speech

sialorrhea

excessive saliva production

drooling

seborrhea

excessive secretion of sebum

greasy skin

treatment for parkinson

levadopa/carbidopa combination

sinemet

gold standard drug

effective for 4-6 years

on-off phenomenon sinemet

PT must occur during on phase (1 hour after administration)

long term adverse effects of Sinemet

dyskinesia

dystonia

nausea and vomitting

orthostatic hypotension

arrhythmias

hallucinations

anticholinergic drugs can be used to

control tremor

amantadine

enhances dopamine release

selegiline

used in early stages

deep brain stimulation

in thalamus or subthalamic nucleus