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Adult-acquired Neurology - Parkinson's Disease

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ness37's version from 2018-05-03 14:16

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DefintionChronic progressive neurological disease. Multi-system neurological disorder which affects cognitive processes, emotion and automatic function
Prevalence Most common progressive neurological condition in UK. Average onset = 60 years. Survival from onset 9-10 years
Motor signs and symptomsBradykinesia (slowing movements), rigidity of muscles (stiffness), postural instability, tremor (at rest - pill rolling), shuffling gait, freezing gait, Hypokinesia (reduced movements), Hypermimia (expressionless face), festination (increasingly fast steps, short/shuffling steps)
Cognitive symptomsDepression, anxiety, psychosis, apathy, sleep disturbance, sexual dysfunction,
Dysautonomic symptomsUrinary problems, sweating, hot/cold sensation, constipation, hypotension, nausea
Sensory symptomsPain, parathesia (prickling, burning, numbness in limbs), loss of smell
Types of PDIdiopathic, drug induced, vascular, MSA, Progressive supra-nuclear palsy
Idiopathic PDMost common form. Main symptoms: tremor, rigidity and slowness of movement
Drug-induced PD 7% diagnosed with PD after treatment with e.g. antipsychotics, most will recover once drug is stopped
Vascular PDAffects those with restricted blood flow to the brain (from small strokes)
MSAIncontinence, swallowing, dizziness etc
Progressive supra-nuclear palsy Eye movement, balance, speech, swallowing affected
Causes Dopamine depletion (80% lost before diagnosis) or Lewy bodies (
DopamineNeurotransmitter which sends signals that help to coordinate movements.
Lewy BodiesTiny deposits of protein in nerve cells, presence is linked to low levels of dopamine (also causes dementia)
Risk factorsAdvancing age, family history, pesticides/herbicides (farming communities), handling heavy metals, repeated head trauma, proximity to industry
DiagnosisNo clinical test. Have to present with Bradykinesia and 1 other motor symptom (rigidity, tremor, postural, instability) Unified Parkinson's disease rating scale (comprehensive 50 questions assessment)
Stages Symptoms on one side of the body only -> bilateral symptoms -> impaired postural reflexes -> severe disability -> wheelchair bound/bedridden
Treatment(1) Levodopa for Idiopathic PD (synthetic dopamine), (2) other drug regimes (mimic dopamine, blocks break down of dopamine) (3) deep brain stimulation (surgically implanted neurostimulator (collarbone) which blocks the abnormal nerve signals from causing temor/symptoms
Side effectsLevodopa: Postural hypotension, pain, depression, paranoia, dyskinesia, on/off effect. On speech = increased rate and volume during 'on' stage, pitch and articulation unchanged. LSVT to not be started before deep brain stimulation.
MDTPD specialist nurse, neurologist, GP, social worker, physio, OT, SLT and dietician.
Implications for speechHypokinetic dysarthria - voice (leading deficit in initial stages), articulation and fluency, mono-pitch/mono-loudness, reduced breath support and phonation time, imprecise C's, dysfluency (repetition of phonemes, syllables, words and phrases)
Implications for language Problems with providing definitions and sentence constructions, difficulty with naming and verbal fluency
LSVTFocus on increasing vocal loudness by increasing phonatory effort (think LOUD) long and short term efficacy data
Implications for swallowDysphagia is common in PD, slow to swallow, poor bolus formation, food residue in oral cavity, difficulties initiating tongue movement, hand-mouth coordination affected
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