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Year 4 TCDs > Ageing: Movement Disorders > Flashcards

Ageing: Movement Disorders Flashcards

1
Q

What is the pathophysiology of Parkinson’s Disease?

A
  1. Presence of Lewy Bodies (alpha-synuclein aggregates)

2. Loss of dopaminergic cells from the Substantia Nigra (which causes the motor signs/symptoms)

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2
Q

What are the 4 classical motor symptoms of PD?

A
  1. Bradykinesia
  2. Resting tremor
  3. Muscular rigidity
  4. Gait/postural instability
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3
Q

What are 7 non-motor symptoms of PD?

A
  1. Olfactory dysfunction
  2. Cognitive impairment
  3. Psychiatric symptoms
  4. Sleep disorders
  5. Autonomic dysfunction (i.e. urinary incontinence, constipation, postural hypotension)
  6. Pain
  7. Fatigue
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4
Q

What is the diagnosing criteria for PD?

A

Bradykinesia + 1 or more of the following:

  • Muscular rigidity
  • Resting tremor (4-6Hz)
  • Postural instability not caused by visual/cerebellar/vestibular/proprioceptive dysfunction
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5
Q

Which 4 gene mutations carry a high risk of PD development?

A
  1. GBA
  2. LRRK2
  3. SNCA
  4. parkin
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6
Q

What is the first line treatment for PD?

A

Levodopa (dopamine agonist) with dopadecarboxylase inhibitors (to prevent peripheral side effects + improve therapeutic response)

  1. Co-Beneldopa/Co-Careldopa
  2. Ropinirole
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7
Q

What adjuvant therapy can be used for PD if a patient has developed dyskinesia despite levodopa therapy?

A
  1. MAO-B inhibitor (i.e. rasagiline, selegiline)

2. COMT inhibitor (i.e. entacapone, tolcapone)

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8
Q

What brain imaging may be used to assist in PD diagnosis?

A

DaTscan (specific PET scan)

- Only used when differentiating between PD and essential tremor

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9
Q

Name 4 drugs that can cause drug-induced PD

A
  1. Cyclizine
  2. Metoclopramide
  3. Haloperidol
  4. Prochlorperazine

(antipsychotics + dopamine antagonists)

**Patient will present with bilateral onset (idiopathic PD = unilateral onset)

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10
Q

What are the signs of a vascular PD?

A
  • Small vessel disease
  • Symmetrical symptoms
  • Legs more affected than arms (shuffling gait with normal arm swings)

“Marche à petits pas”

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11
Q

What are 4 features of essential tremor?

A
  1. Bilateral
  2. Family history (autosomal dominant)
  3. Worse on movement
  4. Jaw or leg tremor
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12
Q

List 5 conditions where tremors are worse on movement

A
  1. Essential tremor
  2. Exaggerated physiological tremor
  3. Dystonic tremor
  4. Hyperthyroidism
  5. Drug induced
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13
Q

List 1 condition that causes an intention tremor

A

Cerebellar disorders

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14
Q

What medication can be used to treat essential tremor?

A

Propranolol (non-specific b-blocker)

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15
Q

What are the 3 main features of LB dementia?

A
  1. Dementia
  2. Parkinsonism
  3. Visual hallucinations
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16
Q

What is the main feature of multi-system atrophy?

A

Symmetrical parkinsonism with early autonomic features (hypotension, incontinence)

17
Q

What are 3 features of progressive supranuclear palsy?

A
  1. Early falls
  2. Truncal rigidity
  3. Vertical gaze palsy
18
Q

What sign is observed on MRI in someone with supranuclear palsy?

A

Hummingbird sign

- Reduction in mid-brain volume

19
Q

What triad of features are seen in normal pressure hydrocephalus?

A
  1. Dementia
  2. Gait disorder
  3. Bladder instability
20
Q

What is the initial management of normal pressure hydrocephalus?

A
  1. Diagnostic lumbar puncture
  2. CSF removal
  3. Verticulo-peritoneal shunt
21
Q

What are 4 features of cortico-basal degeneration?

A
  1. Asymmetrical parkinsonism
  2. Dyspraxia (poor coordination)
  3. Alien limb syndrome
  4. Cortical sensory deficit
22
Q

What are 5 facial features of Parkinsonism that can be observed in patients?

A
  1. Blepharospasm (abnormal contraction of eyelid muscles)
  2. Orofacial dyskinesia
  3. Reduced facial expression (hypomimia)
  4. Reduced rate of blinking
  5. Hypophonia
23
Q

What are 5 main complications of longterm dopamine agonist therapy?

A
  1. Sudden on/off phenomena
  2. Peak dose dyskinesia
  3. Confusion
  4. Hallucinations
  5. Impulse control disorders
24
Q

List 3 or more supportive criteria that are required to confirm a diagnosis of PD (there are 8 in total)

A
  1. Unilateral onset
  2. Resting tremor present
  3. Progressive disorder
  4. Persistent asymmetry affecting the side of onset most
  5. Excellent response to Levodopa
  6. Severe levodopa-induced chorea
  7. Levodopa response for over 5y
  8. Clinical course of over 10y
25
Q

What are the 3 main drug classes that have been approved for initial symptomatic therapy for PD?

A
  1. Levodopa
  2. Dopamine agonist
  3. Monoamine-oxidase-B (MOA-B) inhibitors
26
Q

What is the most likely side effect of levodopa treatment?

A

Postural hypotension

Year 4 TCDs (16 decks)

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