Clinical Features of Parkinson's Disease Flashcards
State the motor and non-motor features of PD Understand and discuss the rational basis for drug treatments of PD and the main complications of treatment Appreciate and discuss the non-medication based aspects of PD management, relating both to the patient, family, carers, and society at large
Name the four core features of Parkinson’s disease
Pill-rolling tremor, rigidity, bradykinesia, and loss of postural reflexes
Name four domains affected by Parkinson’s disease
Motor, neuropsychiatric, autonomic, and sleep
Give at least 4 motor symptoms of Parkinson’s disease
Tremor, rigidity, akinesia, bradykinesia, clumsiness, loss of postural reflexes, falls, dystonia, cramps
Give at least 4 neuropsychiatric symptoms of Parkinson’s disease
Hallucinations, anxiety, confusion, stupor, impulsivity, depression, cognitive decline, dementia, paranoia, visuospatial dysfunction
Give at least 4 autonomic and vegetative symptoms of Parkinson’s disease
Bladder and bowel dysfunction, hypotension, impotence dysarthria, dysphagia, drooling, rash, anosmia
Give at least 4 sleep symptoms of Parkinson’s disease
Restless leg syndrome, REM sleep disorder, nightmares, nocturia, periodic limb movement disorder, immobility, pain
Give 2 classes of drugs which can cause parkinsonism
Dopamine blockers and calcium blockers
Where does Parkinson’s disease pathology typically start?
The dorsal basal nucleus and vagus nerve, and the olfactory system
Name 2 other alpha-synucleinopathies
Dementa with Lewy bodies and multiple system atrophy
Name the 3 disorders encompassed by multiple system atrophy
Olivopontocerebellar atrophy (OPCA), striatonigral degeneration, and Shy-Drager syndrome
Name 2 tauopathies which cause parkinsonism
Corticobasal degeneration and progressive supranuclear palsy
State the prevalence of Parkinson’s disease
0.2-0.4%, increasing with age
State the prevalence of Parkinson’s disease in those over 65
2-3%
Degeneration of which systems produces motor symptoms?
Substantia nigra and pedunculopontine nucleus (PPN)
Degeneration of which systems produces sleep symptoms?
Hypothalamus, pedunculopontine nucleus (PPN), thalamus, raphe nucleus, RAF
Degeneration of which systems produces autonomic symptoms?
Hypothalamus, medullary nuclei, spinal cord, peripheral ganglia
Degeneration of which systems produces cognitive symptoms?
Substantia vigra, ventral tegmental area (VTA), locus coeruleus, raphe nucleus, basal forebrain, limbic system, hippocampus, cerebral cortex, thalamus
Degeneration of which systems produces sensory symptoms?
Olfactory pathway, visual pathway, association cortex
Name the 2 main neurotransmitter’s involved in Parkinson’s disease
Dopamine and acetylcholine
Name 2 indirect dopamine agonists used in Parkinson’s disease
L-DOPA (dopamine precursor) and amantadine (increases dopamine release)
Name at least 2 direct dopamine agonists used in Parkinson’s disease
Apomorphine, pramipexole, ropinirole, rotigotine
Name at least 2 COMT inhibitors used in Parkinson’s disease
Entacapone, tolcapone, opicapone
Name 2 MAO inhibitors used in Parkinson’s disease
Selegiline, rasagiline
Why must levodopa be co-administered with a decarboxylase inhibitor?
To prevent it being converted to dopamine outside of the CNS
How much levodopa reaches the brain?
Less than 5%
Why can dextrodopa not be used?
It causes haematological toxicity
Name 2 sustained release levodopa formulations and the symptom group they are most effective for
POS: Increased active time, tends to improve sleep
NEG: Slow active onset, tends to improve dyskinesia
Why should levodopa be avoided in younger patients
To delay the development of tolerance
State some side effects of dopamine agonists
Nausea, vomiting, hypotension, somnolence, sleep attacks
What is the most common autonomic symptom of PD?
Constipation
Which antipsychotics can be used in PD?
Clonazepam, quetiapine, aripiprazole, or clozapine
What is the most common neuropsychiatric symptom of PD?
Confusion and agitation
What percentage of PD patients experience memory loss?
50%
Give 2 palliative treatments for treatment-resistant PD
Deep brain stimulation or high-energy ultrasound
