Exam 3: Parkinson's Disease

Question 1

Parkinson’s Pathophysiology

Answer 1

Destruction of dopaminergic neuronal cells in substantia nigra in basal ganglia

Risk factors: Genetics, age over 50, male, pesticide exposure, head injury, multi-factorial

Question 2

Diagnosis

Answer 2

Difficult in early stages

No reliable biomarker tests

PET scan

Reliable diagnosis only post-mortem

Based on clinical presentation and response to medications, L-dopa trial responsiveness

Two of four cardinal features: Tremors, rigidity, bradykinesia, postural changes

Question 3

Intention tremor

Answer 3

Tremor when attempting activity

Does not affect lifespan

Question 4

Essential tremor

Answer 4

Rhythmic shaking: Hands, head, trunk, voice

Tremors worse during movement

Do not affect lifespan

Question 5

Parkinsonism

Answer 5

Parkinson type symptoms: Tremors, rigidity

Causes: Lewy body dementia, stroke, medications

Question 6

Signs and symptoms

Answer 6

Tremor
Rigidity
Bradykinesia or akinesia
Postural instability
Micrographia
Hypophonia
Loss of smell
Trouble sleeping (movement)
Constipation
Masked facies
Dizziness or fainting
Stooped or hunched over
Decreased arm swing

Question 7

Potential complications

Answer 7

Dementia risk increased
Dysphagia
Orthostatic hypotension
Sleep disorders
General debilitation/fragility

Question 8

Treatment goals

Answer 8

Maximize neuromuscular function

Maintain independence in ADLs for as long as possible

Optimize psychosocial well-being

Question 9

Levodopa/Carbidopa

Answer 9

First line treatment

Symptom relief best in first couple of years, then benefits wane within 5-10 years, “on-off” syndrome or dyskinesia

Adverse effects: Hypotension, anorexia, n/v, dystonia, confusion

Question 10

Adjuvant/Additional treatments

Answer 10

Added on when levodopa/carbidopa become less efficient

Antivirals: Amantadine - increases dopamine release

Dopamine receptor agonists: Ropinorole - stimulates dpamine receptors