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Medical Studies 2A > 5.2 Disorders of the Basal Ganglia: Parkinson’s Disease > Flashcards

5.2 Disorders of the Basal Ganglia: Parkinson’s Disease Flashcards

1
Q

What are the five primary symptoms of Parkinson’s Disease? What are the criteria necessary for diagnosis of Parkinson’s based on these symptoms?

A
  1. Resting tremor
  2. Rigidity
  3. Akinesia
  4. Bradykinesia
  5. Gait change

Must have at least two, and at least one must be tremor/bradykinesia.

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2
Q

What are the five overarching categories of non-motor Parkinson’s symptoms?

A
  • Personality/behaviour
  • Autonomic
  • Sensory
  • Cognition/mental
  • Sleep problems
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3
Q

What are some personality/behavioural symptoms of Parkinson’s?

A
  • Depression
  • Fear
  • Passivitiy
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4
Q

What are some autonomic symptoms of Parkinson’s?

A
  • Bladder problems
  • Constipation
  • Sexual dysfunction
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5
Q

What are some sleep related symptoms of Parkinson’s?

A
  • Increased sleep fragmentation
  • Excessive daytime sleepiness
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6
Q

What are some sensory symptoms of Parkinson’s?

A
  • Pain
  • Numbness
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7
Q

Within 20 years of diagnosis __% of patients with Parkinson’s will have developed dementia.

A

80%. (80/20 rule)

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8
Q

Can you be diagnosed with Parkinson’s Dementia without Parkinson’s? If not, what is it referred to as?

A
  • No. That would be stupid.
  • Instead, we refer to it as dementia with Lewy bodies.
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9
Q

What are the biggest predictors of quality of life for patients with Parkinson’s?

A
  • Cognitive decline
  • Depression
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10
Q

There is no definitive test for diagnosis of Parkinson’s disease. What is the basic algorithm?

A
  • IF someone presents with motor symptoms…
  • AND there is no other obvious diagnosis…
  • AND there is a positive response to L-dopa
  • We diagnose Parkinson’s
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11
Q

Does Parkinson’s disease begin suddenly? How long is average survival afterward?

A
  • No; it begins insidiously
  • Average survival is 12 years
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12
Q

What symptoms can be found in a Parkinson’s patient DECADES before the disease?

A
  • Loss of sense of smell
  • REM sleep behaviour disorder
  • GI changes (e.g. constipation)
  • Depression
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13
Q

Describe the five stages of Parkinson’s disease

A

Stage 1: Unilateral motor dysfunction
Stage 2: Bilateral motor dysfunction
Stage 3: Worsening symptoms, but still independent
Stage 4: severe disability, but still able to walk
Stage 5: Wheelchair/bed bound unless assisted

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14
Q

True or false: people with Parkinson’s disease are the only people who experience dopaminergic loss

A
  • False
  • Everyone experiences it while they age
  • They just experience it faster
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15
Q

What are symptoms that appear as part of the later stages of the natural history of Parkinson’s disease?

A
  • Dysphagia
  • Falls
  • Inability to walk
  • Psychosis
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16
Q

Describe how Parkinson’s produces tremor (despite REDUCING movement) - which network?

A
  • Increased inhibitory signals from GPi/SNr suffocates thalamus
  • It alters its firing patterns
  • This alters activity within the cerebello-thalamo-cortical network, producing tremor
17
Q

Name four classes of anti-Parkinson’s drugs

A
  • L dopa
  • Dopamine agonists
  • COMT Inhibitor
  • MAO inhibitor
18
Q

Describe the mechanism of L dopa for Parkinson’s. Why is it given with a decarboxylase inhibitor?

A
  • Precursor for dopamine, converted in the body to replenish striatal dopamine
  • Given with decarboxylase inhibitor to prevent increase in peripheral dopamine
19
Q

What are some adverse effects of L Dopa + decarboxylase inhibitor?

A
  • Postural dizziness
  • Confusion
  • Nausea
20
Q

Which is more likely to cause psychiatric side effects: L dopa or dopamine agonists?

A

Dopamine agonists

21
Q

What are some side effects of dopamine agonists?

A
  • Nausea
  • Postural dizziness
  • Confusion
  • Gambling/shopping addiction (obsession)
22
Q

Which type of Parkinson’s medication is contraindicated by serotonergic drugs?

A

MAO inhibitors (monoamine oxidase)

23
Q

Monoamine oxidase inhibitor mech:

A

IRREVERSIBLY inhibit enzyme; reduces dopamine breakdown/reuptake in synapse

(Mao wasn’t fucking around)

24
Q

MAO inhibitor side effects

A
  • Nausea
  • Postural dizziness
  • Confusion
25
Q

COMT inhibitor stands for…

A

Catecholomethyl transferase inhibitor

26
Q

The suffix for COMT inhibitors is…

A

Capone (fuhgedaboudit)

27
Q

COMT inhibitor mechanism

A
  • Inhibits enzyme that breaks down L dopa
  • More availability in brain, hence more dopamine
28
Q

In which patients are COMT inhibitors especially used?

A

Patients who get motor fluctuations from L dopa itself.

29
Q

COMT inhibitor side effects…

A
  • Confusion
  • Nausea

Medical Studies 2A (110 decks)

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