Delirium and Parkinsons Flashcards
mean age of onset of parkinsons?
60
is parkinsons more common in males or females?
males
what is associated with increased risk of parkinsons?
higher risk if first degree relative affected drinking well water pesticide exposure farming rural dwelling smoking reduces risk
criteria for parkinsons diagnosis?
bradykinesia + 1 out of
- muscular rigidity
- resting tremor (4-6Hz)
- postural instability (not caused by visual, cerebellar, vestibular or proprioceptive dysfunction)
what is bradykinesia?
slowing and fatiguing of movement and reduced amplitude of movement
eg: slow shuffling gait, reduced arm swing, slow turning, fine movement like tapping finger gets v easily fatigued
type of rigidity in parkinsons?
lead pipe rigidity (sustained resistance to movement throughout whole range of motion) cogwheel rigidity (jerky resistance to movement as muscles tense and relax)
what criteria excludes parkinsons?
repeated strokes and stepwise progression
repeated head injury
history of definite encephalitis
oculogyric crisis
neuroleptic treatment at onset
more than one affected relative (think about direct genetic cause)
sustained remission (parkinsons is progressive)
what symptoms might help exclude parkinsons?
strictly unilateral symptoms after 3 years supranuclear gaze palsy cerebellar signs early severe autonomic involvement early severe dementia babinski sign (upgoing plantar indicating UMN problem) cerebral tumour or hydrocephalus negative response to levodopa MPTP
what criteria would support a diagnosis of parkinsons?
unilateral onset resting tremor progressive disorder persistent asymmetry affecting site of onset most excellent response to levodopa severe levodopa induced chorea levodopa response lasting 5+ years clinical course of 10+ years
types of tremor?
essential tremor
dystonic tremor
cerebellar tumour
functional tremor
what is essential tremor?
often AD inheritance
bilateral, postural tremor (tremor while maintaining a position against gravity like holding arms outstretched)
worsens over time
alcohol reduces tremor
what is dystonic tremor?
large variable, jerky tremor asymmetrical dystonia often present (sustained muscle contraction) worse in particular positions or tasks little response to propanalol
what is a cerebellar tremor?
slow, high amplitude intention tremor which can be caused by:
- demyelination
- ischaemia
- toxins (drugs and alcohol)
- paraneoplastic
- spinocerebellar ataxia
(intention tremor = shaking towards end of movement eg if going to press a button person will have upper limb tremor the closer they get to the button)
examples of parkinson plus syndromes (atypical parkinsonism)?
progressive supranuclear palsy
multiple systems atrophy
lewy body dementia
what is progressive supranuclear palsy?
rare condition causing loss of nerve cells in the brain
main features of progressive supranuclear palsy?
usually symmetrical with no tremor neck dystonia, retrocollis (sustained neck extension) levator inhibition and frontalis overactivity vertical gaze palsy postural instability and early falls dementia dysarthria and dysphagia lack of levodopa response
what is multiple systems atrophy?
degenerative condition affecting autonomic functions
main features of multiple systems atrophy?
parkinsonism with poor response to levodopa autonomic failure early falls and postural instability orofacial dystonia dysarthria myoclonus stridor/sleep apnoea raynauds inappropriate laughing and crying
features of lewy body dementia?
early cognitive problems
fluctuating course
hallucinations
exaggerated and bad response to antipsychotics
facial signs in parkinsons?
reduced facial expression reduced blinking drooling difficult eye movements quiet, monotomous speech loss of sense of smell swallow problems
handwriting in parkinsons?
micrographia (difficulty with fine finger movements)
what drugs are available for parkinsons?
levodopa dopamine agonist MAO-B inhibitor COMT inhibitor apomorphine (s/cut) duodopa
non-medical treatment of parkinsons?
deep brain stimulation
phases of parkinsons disease progression?
diagnostic
maintenance
complex
palliative
how is parkinsons managed in acute setting?
do not stop parkinsons meds
early referral to parkinsons nurse (can advise on meds)
why shouldnt you stop parkinsons drugs in acute setting?
(risk of parkinsonism hyperpyrexia syndrome, loss of function and may take long time to regain function after stopping)
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