Movement disorders and Parkinsons Flashcards

1
Q

TYPES OF MOVEMENT DISORDERS

i) define bradykinesia, chorea, athetosis and hemiballismus
ii) what are these movement disorders usually due to?

A

i) bradykinesia - slow initiation of vol movement, progressive reduc in speed/amplitute of repetitive actions

chorea - jerky flexion and extension movement

athetosis - writhing movements

hemiballismus - flailing movements

ii) usually sue to chronic, progressive NGD condition

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2
Q

TAKING A HISTORY

i) what duration has PD usally been building for? name two things that may be seen as it is developing
ii) does drug induced PD affect both limbs or usually just done?
iii) how can tremor be exaggerated? how can you test if it is an intention tremor?
iv) name two gaits that may be seen in movement disorders

A

i) 6 months to 1 year
- get a tremor and general slowing down eg takes longer to get ready in the morning

ii) drug induced > symmetrical (not true PD)

iii) exagg by asking to count from 100 down to 1 in 7s
- test if intention by doing finger to nose

iv) shuffling gait / feet stuck to floor

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3
Q

PARKINSONS DISEASE

i) which element must be present in PD?
ii) one of which three things must also be present?
iii) what must be absent?
iv) what is M to F ratio? which cells are lost in which brain area?

A

i) must have bradykinesia (general slowing down)
ii) must also have - musc rigidity (lead pipe/cogwheel), resting tremor, post instability (unsteady on feet)
iii) must be absence of complicating factors eg AP treatment, head injury, stroke

iv) 1.3:1 M:F
- loss of DA neurons in substantia nigra

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4
Q

PARKINSONS DISEASE PATHOLOGY

i) name three associated proteins seen in the brain? which protein is mostly impicated
ii) name two differences between PD and lewy body dementia

A

i) see cell death with lewy bodies, neurofibrillary tangles and plaques
- alpha synuclein

ii) LB disease get cog impair in first 1-2 years (later in PD)
- LB doesnt respond well to levodopa treatment (PD does)

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5
Q

PD SYMPTOMS

i) name three mood disorders seen?
ii) name two cognitive changes?
iii) what my be disturbed? how are bowel movements affected?
iv) how is urine affected? how is speech affected?
v) name two non motor symptoms

A

i) apathy, depression, anxiety
ii) cog - mental slowing and dementia

iii) disturbed sleep
- constipation

iv) urine retention and decreased frequency
- quiet monotonous speech

v) non motor - fatigue and pain

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6
Q

PD DIAGNOSIS

i) what type of diagnosis is it? what does this include?
ii) what can may be used? what is seen and what is it good for?
iii) what other type of parkinsonism can present like PD? what RF will these patients have
iv) which two features present early and which feature presents late in true PD and may allow differentiation between other non PD conditions

A

i) clinical dx - includes response to levodopa

ii) can use DAT scan - DA uptake is reduced in PD
- good to differentiate between other causes of essential tremor

iii) vascular parkinsonism > vasc change in brain on imaging
RFs = HTN and IHD - affects lower limbs mostly

iv) tremor/slowing presents early and post hypotension presents late
(if PH presents early - probs not PD)

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7
Q

PD TREATMENT

i) what do current drug treatments aim to do?
ii) name a COMT inhibitor? how do these work? name two side effects
iii) what is co-careldopa?
iv) name two DA agonists? what risks do these come with?
v) what type of drugs are rasagiline and safinamide? what do they do

A

i) aim to mainip NTs around degen neurons

ii) COMT inhib = entacapone > stop DA breakdown
- SEs are diarrhoea and orange secretions

iii) co carledopa = levodopa to replace DA and co stops it bdown in the periphery

iv) DA agonists > ropinorole, pramipexole > work on DA receptors
- risk of impulse control = more risky behavs eg gambling, sexual disinhib

v) rasagiline = MAOB inhibitor > preserve existing DA

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8
Q

PD PROGRESSION

i) in what two phases may the person still lead a normal life and be on 1/2 drugs?
ii) in which stage are DA levels fluctuating and patient becomes more difficult to manage?
iii) after how many years may palliative stage begin?
iv) name five late features of PD

A

i) dx (1-3yrs) and maintenance (3-10yrs)
ii) complex (8-15yrs)
iii) 13 years onwards
iv) late features = falls, cog problems, vivid dreams, hallucinations, autonomic dysfunc, major func limitation, loss of swallow

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9
Q

DRUGS AND MOVEMENT DISORDERS

i) name three drug classes that can cause movement disorders and give an example of each

A

neuroleptics (APs) > flupenthixol

anti emetics - prochloperazine, metoclopramide, cyclizine

anti convulsants - valproate, carbemazepine

SSRIs

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