DISEASE- Parkinsons Flashcards
parkinsons- what?
Parkinson’s disease is a movement disorder characterised by: tremor at rest, rigidity, bradykinesia
what causes parkinsons?
progressive reduction of dopamine in the basal ganglia due to loss of substantia nigra (part of basal ganglia that produces dopamine)
classic triad of parkinsons symptoms?
bradykinesis, rigidity + resting tremor
what is the 2nd most common neurodegenerative disease?
Parkinsons
what age do most people acquire Parkinsons?
> 60 years
what would count as a young onset of Parkinsons?
<40 years
What genes are linked to Parkinsons?
LRRK2
PARKIN
Describe the gait of someone with Parkinsons?
-stooped posture
-Shuffling gait
what type of rigidity is seen in Parkinsons?
Lead pipe rigidity (stiffness on passive limb movement)
Cogwheel rigidity (stiffness that gives away in small incriments like little jerks when moving)
how would you describe the tremor felt by a person with Parkinsons?
Pin rolling tremor
what make a pin rolling tremor better/ worse?
-Tremor is worse on rest and worse if patient is distracted
-Tremor improves on voluntary moveement
What may occur to patients handwriting if they have Parkinsons and why?
-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
are symptoms are Parkinsons usually bilateral or unilateral?
typically unilateral
describe some non motor symptoms of Parkinsons?
-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
How is Parkinsons diagnosed?
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
if Parkinsons is symmetrical, what is the probable cause?
drug induced
what are some pathological hallmarks of Parkinsons?
-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
1st line treatment for motor symptoms impacting quality of life?
Levodopa (synthetic dopamine)
treatment for motor symptoms impacting quality of life if levodopa doesnt work/ patient develops dyskenesia?
Levodopa + one of:
-Dopamine agonist (Bromocriptine, Ropinirole)
-MAO-B inhibitor (Selegiline)
-COMT inhibitor
examples of dopamine agonists?
Bromocriptine + Ropinirole
Examples of MAO-B inhibitors?
Selegiline
Who should you avoid giving dopamine agonists to?
-those with history of addiction problems or compulsive disorders
Treatment for motor symptoms not affecting quality of life?
Dopamine agonists (Bromocriptine/ Ropinirole)
MAO-B inhibitors (Selegiline)
Levodopa
Treatment for motor symptoms not affecting quality of life?
Dopamine agonists (Bromocriptine/ Ropinirole)
MAO-B inhibitors (Selegiline)
Levodopa
SE of Dopamine agonists, Levodopa, MARO-B inhibitors, COMT inhibitors:
N+V
Daytime somnolence
Impulse control disorders (gambling, hypersexuality)
what is useful as a treatment for treatment of tremor in Parkinsons?
anticholinergics/antimuscarinics (same thing)
examples:
-Benzotropine
-Procyclidine
- Trihexyphenidyl (benzhexol)
what is the ‘on and off’ phenomena regarding levodopa?
large variations in motor performance, with normal function during the ‘on’ period, and weakness and restricted mobility during the ‘off’ period
what occurs to symptoms of patient near the end of a levodopa dose?
symptoms often worsen towards the end of dosage interval. This results in a decline of motor activity
what can occur to patients symptoms at peak dose/ over long term use of levodopa?
dystonia, chorea and athetosis (involuntary writhing movements)
