Ageing: Movement Disorders Flashcards
What is the pathophysiology of Parkinson’s Disease?
- Presence of Lewy Bodies (alpha-synuclein aggregates)
2. Loss of dopaminergic cells from the Substantia Nigra (which causes the motor signs/symptoms)
What are the 4 classical motor symptoms of PD?
- Bradykinesia
- Resting tremor
- Muscular rigidity
- Gait/postural instability
What are 7 non-motor symptoms of PD?
- Olfactory dysfunction
- Cognitive impairment
- Psychiatric symptoms
- Sleep disorders
- Autonomic dysfunction (i.e. urinary incontinence, constipation, postural hypotension)
- Pain
- Fatigue
What is the diagnosing criteria for PD?
Bradykinesia + 1 or more of the following:
- Muscular rigidity
- Resting tremor (4-6Hz)
- Postural instability not caused by visual/cerebellar/vestibular/proprioceptive dysfunction
Which 4 gene mutations carry a high risk of PD development?
- GBA
- LRRK2
- SNCA
- parkin
What is the first line treatment for PD?
Levodopa (dopamine agonist) with dopadecarboxylase inhibitors (to prevent peripheral side effects + improve therapeutic response)
- Co-Beneldopa/Co-Careldopa
- Ropinirole
What adjuvant therapy can be used for PD if a patient has developed dyskinesia despite levodopa therapy?
- MAO-B inhibitor (i.e. rasagiline, selegiline)
2. COMT inhibitor (i.e. entacapone, tolcapone)
What brain imaging may be used to assist in PD diagnosis?
DaTscan (specific PET scan)
- Only used when differentiating between PD and essential tremor
Name 4 drugs that can cause drug-induced PD
- Cyclizine
- Metoclopramide
- Haloperidol
- Prochlorperazine
(antipsychotics + dopamine antagonists)
**Patient will present with bilateral onset (idiopathic PD = unilateral onset)
What are the signs of a vascular PD?
- Small vessel disease
- Symmetrical symptoms
- Legs more affected than arms (shuffling gait with normal arm swings)
“Marche à petits pas”
What are 4 features of essential tremor?
- Bilateral
- Family history (autosomal dominant)
- Worse on movement
- Jaw or leg tremor
List 5 conditions where tremors are worse on movement
- Essential tremor
- Exaggerated physiological tremor
- Dystonic tremor
- Hyperthyroidism
- Drug induced
List 1 condition that causes an intention tremor
Cerebellar disorders
What medication can be used to treat essential tremor?
Propranolol (non-specific b-blocker)
What are the 3 main features of LB dementia?
- Dementia
- Parkinsonism
- Visual hallucinations
What is the main feature of multi-system atrophy?
Symmetrical parkinsonism with early autonomic features (hypotension, incontinence)
What are 3 features of progressive supranuclear palsy?
- Early falls
- Truncal rigidity
- Vertical gaze palsy
What sign is observed on MRI in someone with supranuclear palsy?
Hummingbird sign
- Reduction in mid-brain volume
What triad of features are seen in normal pressure hydrocephalus?
- Dementia
- Gait disorder
- Bladder instability
What is the initial management of normal pressure hydrocephalus?
- Diagnostic lumbar puncture
- CSF removal
- Verticulo-peritoneal shunt
What are 4 features of cortico-basal degeneration?
- Asymmetrical parkinsonism
- Dyspraxia (poor coordination)
- Alien limb syndrome
- Cortical sensory deficit
What are 5 facial features of Parkinsonism that can be observed in patients?
- Blepharospasm (abnormal contraction of eyelid muscles)
- Orofacial dyskinesia
- Reduced facial expression (hypomimia)
- Reduced rate of blinking
- Hypophonia
What are 5 main complications of longterm dopamine agonist therapy?
- Sudden on/off phenomena
- Peak dose dyskinesia
- Confusion
- Hallucinations
- Impulse control disorders
List 3 or more supportive criteria that are required to confirm a diagnosis of PD (there are 8 in total)
- Unilateral onset
- Resting tremor present
- Progressive disorder
- Persistent asymmetry affecting the side of onset most
- Excellent response to Levodopa
- Severe levodopa-induced chorea
- Levodopa response for over 5y
- Clinical course of over 10y
