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The cause of Parkinson's Disease is _________
Unknown
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Risk Factors for P.D.
- Age
- Gender
- Genetic
- Exposure to environmental toxins
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Risk Factors for P.D.:
Age
Over 60 years old, risks double from 1-2% to 2-4%
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Risks Factors for P.D.:
Gender
Men are 1.5 times more likely to develop PD than women
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Risk Factors for PD:
Genetic
- Around 5% of PD cases are familial or inherited.
- 13 genes associated with PD, all play a role in dopamine-secreting cell function
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PD results in the following movement and postural abnormalities:
- Resting tremors
- Trouble initiating movement
- Rigidity/Increased muscle tone
- Stooped posture
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Pathophysiology of PD
- Disruption of the extrapyramidal system
- Extrapyramidal tracts associated with basal ganglia, which plays a role in movement
- Substantia Nigra is a component of basal ganglia
- Substantia Nigra is filled with dopamine-secreting neurons which are destroyed or stop working
- Dopamine is an inhibitory neurotransmitter which helps to control movement
- Decreased levels of dopamine cause remaining neurons to be overly excited
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PD damages __________
- Norepinephrine-secreting neurons
- Decreased norepinephrine affects the autonomic nervous system
- This leads to constipation, skin and urinary problems, sexual dysfunction
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There is also the presence of _____ ______ in PD
- Lewy Bodies
- Lewy bodies are clumps of proteins found in the brains of most PD patients
- Leads to dementia and memory loss
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Early signs and symptoms of PD
- Fatigue
- Muscle weakness
- Muscle aching
- Decreased flexibility
- Less spontaneous in facial expression
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More obvious signs of PD
- Resting tremors - pill rolling. Affects one side before the other
- Increased muscle rigidity
- Difficulty initiating movement
- Bradykinesia
- Loss of automatic movements like smiling, blinking, moving arms while walking
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Type of posture in PD
- Stooped posture
- Leaning forward with head and neck flexed
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Type of gait in PD
- Festination/Propulsion gait
- Short/shuffling steps that increase in speed over time - leads to falls
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"Freezing Period" in PD patients
Person feels stuck and finds it difficult to start moving again
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Tremors in PD affects what first and then what next?
- Affects hands, arms, and legs first
- Moves to the jaw, tongue, forehead, and eyelids next
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Clinical features of PD that are non-motor functions
- Dysarthria
- Voice bcomes low and devoid of inflection
- Chewing/swallowing difficult
- Masked face - reduced blinking, blank staring face
- Autonomic Dysfunction - urinary retention, constipation, orthostatic hypotension, skin problems, sexual dysfunction
- Pain
- Memory loss
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Co-morbidities of PD
- Dementia-develops late in course of 20% of affected persons
- Urinary tract and respiratory infections
- Mood and anxiety disorders - depression, fear, anxiety
- Disturbed sleep, fatigue, and compulsive behavior such as gamblin
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Diagnostic Testing of PD
Currently no diagnostic testing known for PD
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Physician can perform what tests in PD
- Medical history
- Physical Examination
- Observation
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5 common stages of PD
- Stage 1 - unilateral symptoms
- Stage 2 - bilateral symptoms
- Stage 3 - balance problems develop, no ssistive device needed
- Stage 4 - assistance needed during ambulation
- Stage 5 - wheel chair bound or bed ridden
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Juvenile Parkinson's Disease
- Extremely rare
- Symptoms begin before age 20
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Early-Onset Parkinson's Disease
- Farely rare
- Symptoms begin between 20-40 years old
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Medications used in treating PD
- Carbidopa/Levodopa - Levodopa converted into dopamine and Carbidopa helps it get past blood brain barrier
- Dopamine agonists
- Anticholinergics
- MAO-B inhibitors
- COMT inhibitors
- Glutamate (NMDA) blocking drugs
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Treatments for PD
- Medications
- Deep brain stimulation
- PT and OT improve muscular function, gait, and balance, and ADLs
- Speech Therapists help with speaking and swallowing problems
- Dietary modification to avoid constipation
- Massage
- Yoga
- Tai Chi
- Exercise
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