DISEASE- Parkinsons

Question 1

parkinsons- what?

Answer 1

Parkinson’s disease is a movement disorder characterised by: tremor at rest, rigidity, bradykinesia

Question 2

what causes parkinsons?

Answer 2

progressive reduction of dopamine in the basal ganglia due to loss of substantia nigra (part of basal ganglia that produces dopamine)

Question 3

classic triad of parkinsons symptoms?

Answer 3

bradykinesis, rigidity + resting tremor

Question 4

what is the 2nd most common neurodegenerative disease?

Answer 4

Parkinsons

Question 5

what age do most people acquire Parkinsons?

Answer 5

> 60 years

Question 6

what would count as a young onset of Parkinsons?

Answer 6

<40 years

Question 7

What genes are linked to Parkinsons?

Answer 7

LRRK2
PARKIN

Question 8

Describe the gait of someone with Parkinsons?

Answer 8

-stooped posture
-Shuffling gait

Question 9

what type of rigidity is seen in Parkinsons?

Answer 9

Lead pipe rigidity (stiffness on passive limb movement)

Cogwheel rigidity (stiffness that gives away in small incriments like little jerks when moving)

Question 10

how would you describe the tremor felt by a person with Parkinsons?

Answer 10

Pin rolling tremor

Question 11

what make a pin rolling tremor better/ worse?

Answer 11

-Tremor is worse on rest and worse if patient is distracted
-Tremor improves on voluntary moveement

Question 12

What may occur to patients handwriting if they have Parkinsons and why?

Answer 12

-Handwriting becomes smaller (get them to write the same sentence multiple times and it may get smaller)

This is due to the symptom of decrement:
-patient may be tapping fingers together and amplitude decreases

Question 13

are symptoms are Parkinsons usually bilateral or unilateral?

Answer 13

typically unilateral

Question 14

describe some non motor symptoms of Parkinsons?

Answer 14

-Sleep disorders
-Hallucinations
-GI dysfunction (constipation)
-Depression
-Cognitive impairment/dementia
-Anosmia
-Issues with speech and swallowing
· Speech becomes quiet, indistinct and flat
· Drooling
· Swallowing difficulty is a late feature that may eventually lead to aspiration pneumonia as a terminal event

Question 15

How is Parkinsons diagnosed?

Answer 15

NICE recommends using the UK Parkinsons Disease Society Brain Bank Diagnostic Criteria

Clinical diagnosis:
Bradykinesia and one or more of the following:
-Resting tremor
-Rigidity
-Postural instability

Question 16

if Parkinsons is symmetrical, what is the probable cause?

Answer 16

drug induced

Question 17

what are some pathological hallmarks of Parkinsons?

Answer 17

-Sections through the brainstem reveal loss of normal dark black pigment in the substantia nigra and locus coeruleus
-Pigment loss correlates with dopaminergic cell loss
-Neurohistological hallamark of PD are Lewy bodies

Question 18

1st line treatment for motor symptoms impacting quality of life?

Answer 18

Levodopa (synthetic dopamine)

Question 19

treatment for motor symptoms impacting quality of life if levodopa doesnt work/ patient develops dyskenesia?

Answer 19

Levodopa + one of:

-Dopamine agonist (Bromocriptine, Ropinirole)
-MAO-B inhibitor (Selegiline)
-COMT inhibitor

Question 20

examples of dopamine agonists?

Answer 20

Bromocriptine + Ropinirole

Question 21

Examples of MAO-B inhibitors?

Answer 21

Selegiline

Question 22

Who should you avoid giving dopamine agonists to?

Answer 22

-those with history of addiction problems or compulsive disorders

Question 23

Treatment for motor symptoms not affecting quality of life?

Answer 23

Dopamine agonists (Bromocriptine/ Ropinirole)
MAO-B inhibitors (Selegiline)
Levodopa

Question 23

Treatment for motor symptoms not affecting quality of life?

Answer 23

Dopamine agonists (Bromocriptine/ Ropinirole)
MAO-B inhibitors (Selegiline)
Levodopa

Question 24

SE of Dopamine agonists, Levodopa, MARO-B inhibitors, COMT inhibitors:

Answer 24

N+V
Daytime somnolence
Impulse control disorders (gambling, hypersexuality)

Question 25

what is useful as a treatment for treatment of tremor in Parkinsons?

Answer 25

anticholinergics/antimuscarinics (same thing)
examples:
-Benzotropine
-Procyclidine
- Trihexyphenidyl (benzhexol)

Question 26

what is the ‘on and off’ phenomena regarding levodopa?

Answer 26

large variations in motor performance, with normal function during the ‘on’ period, and weakness and restricted mobility during the ‘off’ period

Question 27

what occurs to symptoms of patient near the end of a levodopa dose?

Answer 27

symptoms often worsen towards the end of dosage interval. This results in a decline of motor activity

Question 28

what can occur to patients symptoms at peak dose/ over long term use of levodopa?

Answer 28

dystonia, chorea and athetosis (involuntary writhing movements)