7: Parkinson's disease

Question 1

Parkinson’s disease becomes symptomatic (early / late) in its course.

Answer 1

late

Question 2

Which pathway is most responsible for motor function?

Answer 2

Corticospinal tract

Question 3

Which parts of the brain are responsible for adjusting movement information?

Answer 3

Basal ganglia

Question 4

What is the role of the cerebellum in movement?

Answer 4

Coordination

Question 5

What is the difference between Parkinson’s disease and Parkinsonism?

Answer 5

Parkinson’s disease - specific disease process causing symptoms

Parkinsonism - PD-like symptoms caused by other factors e.g dopamine antagonists

Question 6

Which gait is caused by damage to the cerebellum?

Answer 6

Ataxic gait

Question 7

What are the five basal ganglia?

Answer 7

Caudate nucleus

Putamen

Globus pallidus

Substantia nigra

Subthalamic nucleus

Question 8

What is the role of the basal ganglia?

Answer 8

Adjustment of movement impulses

Question 9

Which neurotransmitters are involved in PD?

Answer 9

Dopamine

Noradrenaline

Acetylcholine

Serotonin

Question 10

Which basal ganglion degenerates in PD?

Answer 10

Substantial nigra

Question 11

Which type of neuron is lost from the substantia nigra in PD?

Answer 11

Dopaminergic neuron

Question 12

What is the hallmark of PD on histology?

Answer 12

Lewy bodies

Question 13

___ bodies are a hallmark of PD.

Answer 13

Lewy bodies

Question 14

Where in the brain is the substantia nigra found?

Answer 14

Brainstem

Question 15

Does PD spread from the substantia nigra?

Answer 15

Yes

Question 16

___ neurons are lost from the substantia nigra in PD, causing (sensory / motor) symptoms.

Answer 16

Dopaminergic neurons

Motor symptoms

Question 17

What are the motor symptoms of PD?

Answer 17

Resting tremor

Bradykinesia (slower movements)

Rigidity

Postural instability

Question 18

Resting tremor in PD is (symmetrical/asymmetrical).

Answer 18

asymmetrical

best seen with hands in the lap

Question 19

What is bradykinesia?

Answer 19

Reduced speed of movement

Question 20

What is rigidity?

Answer 20

Increased muscle tone throughout a movement

Like dystonia - produces a stiff, “bent forward” posture

Question 21

Where do PD patients experience rigidity?

Is it unilateral or bilateral?

Answer 21

Back, neck, limbs

Unilateral in limbs

Question 22

How do you test postural stability in a patient?

Answer 22

Challenge standing posture

If PD, they will likely fall over

Question 23

People with PD often have a reduced sense of ___.

Answer 23

smell

Question 24

Broadly, there are two subtypes of PD: ___-dominant and non-dominant.

Answer 24

tremor dominant

temor non-dominant (emphasis on rigidity, postural instability)

Question 25

What are some possible **non-motor symptoms** of Parkinson's disease?

Answer 25

**Associated with DWLB** - dementia, hallucinations **Anosmia** **Sleep disorders**

Question 26

Describe two types of **rigidity** seen in **Parkinson's disease.**

Answer 26

**Lead pipe rigidity** - constant resistance to movement throughout a range of motion **Cogwheel rigidity** - points of increased / decreased resistance to movement through a range of motion as muscle tension increases and decreases

Question 27

You need to rule out ___ Parkinsonism or other neurological diseases before diagnosing PD.

Answer 27

secondary

Question 28

Patients should be tested on drugs affecting which neurotransmitter before being diagnosed with PD?

Answer 28

dopamine

Question 29

Parkinson's disease is a diagnosis of \_\_\_.

Answer 29

exclusion

Question 30

What is the biggest risk factor for PD?

Answer 30

Increasing age

Question 31

PD has a strong ___ component.

Answer 31

genetic

Question 32

The gene for which protein has been proven to be involved in the formation of Lewy bodies?

Answer 32

Alpha synuclein

Question 33

Alpha synuclein is a protein found in ___ \_\_\_ which is thought to be involved in PD.

Answer 33

Lewy bodies

Question 34

What are the investigations for PD?

Answer 34

Very few i.e there aren't any

Question 35

How is PD treated?

Answer 35

Dopaminergic treatment i.e Dopamine agonists, which alleviate motor symptoms

Question 36

What are the side effects of Dopamine agonists and levodopa?

Answer 36

N&V Oedema Increased reward response --\> gambling, hypersexuality, risk taking behaviour Psychosis

Question 37

Dopaminergic therapy treats the ___ symptoms of PD.

Answer 37

motor

Question 38

How is the non-motor aspect of PD treated?

Answer 38

Specific therapies for each symptom