17 - PD clinical

Question 1

4 clinical features of PD

Answer 1

tremor, bradykinesia, rigidity, postural instability/gait disorder

Question 2

diagnosis favored by? (5)

Answer 2

unilateral onset, asymmetry, rest tremor, levodopa response, dsykinesias

Question 3

atypical features (6)

Answer 3

early dementia, hypotension, supranuclear palsy, cerebellar signs, pyramidal signs, gait and balance

Question 4

pathophysiology of PD: 3?

Answer 4

neurochemical changes, striatal changes, cortical dysfunction

Question 5

4 neurochemical changes

Answer 5

DA, NA, 5HT, ACh

Question 6

cholinergic loss in AD vs. PD

Answer 6

PD: has more cholinergic loss

Question 7

8 early non motor symptoms

Answer 7

smell loss. REM sleep behaviour disorder, restless leg syndrome, fatigue, depression, anxiety, apathy, consitpation

Question 8

tremor: what type? hz?

Answer 8

5 - 9 Hz rest tremor

Question 9

rigidity: type? distict from?

Answer 9

cogwheel rigidity: rate independent stiffness with superimposed tremor. distinct from spasticity: rate dependent stiffness

Question 10

relationship b/w neuron density and UPDRS score?

Answer 10

linear relationship: decreased density of neurons = higher/worse score

Question 11

selective loss in PD?

Answer 11

more in the ventral part of nigra

Question 12

DA transporter imaging?

Answer 12

PD: see less, also asymmetric. if you had essential termor you wouldn’t see change from control

Question 13

late PD: complications?

Answer 13

within 3 years up to 50% develop wearing off or on/off, dyskinesias, freezing. also neuropsych and autonomic complications

Question 14

motor complications young vs. old

Answer 14

young have worse fluctuations and dyskinesias : more plasticity?

Question 15

treatment of wearing off: if on DA agonist? if on levadopa or decarboxylase inhibitor?

Answer 15

DA agonist: increase amount. L/DI: increase dose frequency or switch to controlled release.

Question 16

treatment of dyskinesias: ex? effective for who?

Answer 16

preventive with DA agonists. surgery, amantadine. effective in younger, no difference in older once dysk has developed

Question 17

agonists and dyskinesia risk?

Answer 17

agonists reduce risk: not as good benefit, but less likely to get dyskinesia

Question 18

postural and gait impairment: severity? prognosis? medication? may suggest?

Answer 18

rarely severe early in course of disease. worse prognosis. not as responsive to medications. involvement of other distinct nuclei or wide spread disease, alternate diagnosis.

Question 19

dementia in PD?

Answer 19

prevalence 10 - 40%, shortens survival

Question 20

risk factors for PD (4)

Answer 20

older age, low education, decrease memory + verbal fluency, axial motor impairment

Question 21

type of lewy bodies?

Answer 21

diffuse