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Year 4 - Neurology and Special Senses > Neurology - Parkinson's Disease > Flashcards

Neurology - Parkinson's Disease Flashcards

1
Q

What is Parkinson’s disease?

A

Progressive reduction in dopamine in the basal ganglia, leading to movement disorders

Symtpoms are typically assymetrical

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2
Q

What is the typical Parkinson’s patient?

A

Older man around 70
Gradual symptom onset

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3
Q

What are the classic triad features of Parkinson’s disease?

A
  • Resting tremor
  • Rigidity
  • Bradykinesia
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4
Q

What is the role of dopamine in the basal ganglia?

A

Essential for coordinating habitual movements and controlling voluntary movements

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5
Q

Describe the characteristics of the tremor in Parkinson’s disease

A

Worse on one side
4-6 hertz frequency
Improves with voluntary movement
Pill-rolling tremor

More noticeable when resting, imrpoves on movement

Worse when patient is distracted e.g. using other hand

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6
Q

What is rigidity in Parkinson’s disease?

A

Resistance to passive movement of a joint

Jerking resistance to movement

Ccogwheel rigidity

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7
Q

How does bradykinesia present in Parkinson’s

A
  • Micrographia
  • Shuffling gait
  • Rapid frequency of steps to compensate for small steps and avoid fallnig Festinating gait
  • Difficulty initating movement
  • Difficulty in turning around when standing
  • Reduced facial movements and expression (hypomimia)
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8
Q

What are some other features associated with Parkinson’s disease?

A
  • Depression
  • Sleep disturbance
  • Anosmia
  • Postural instability
  • Cognitive impairment
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9
Q

Complete the table

A
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10
Q

Name some Parkinson’s-plus syndromes

A
  • Multiple system atrophy
  • Dementia with Lewy bodies
  • Progressive supranuclear palsy
  • Corticobasal degeneration
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11
Q

What is multiple system atrophy?

A

A rare condition with degeneration of various brain systems, including the basal ganglia, leading to a Parkinson’s presentation

Denergation in other areas leads to autonomic dysfunction and cerebellar dysfunction

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12
Q

What are the symptoms associated with dementia with Lewy bodies?

A
  • Progressive cognitive decline
  • Visual hallucinations
  • Delusions
  • REM sleep disorders
  • Fluctuating consciousness
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13
Q

How is Parkinson’s disease diagnosed?

A

Clinically, based on history and examination findings by an experienced specialist

UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria

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14
Q

What is the primary focus of treatment for Parkinson’s disease?

A

Controlling symptoms and minimising side effects

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15
Q

What are the different treatment options for Parkinson’s

A
  • Levodopa (with peripheral decarboxylase inhibitors)
  • COMTis
  • Dopamine agonists
  • Monoamine oxidase-B inhibitors
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16
Q

What is levodopa?

A

Synthetic dopamine taken orally, usually combined with a peripheral decarboxylase inhibitor (e.g. Carbidopa)

Prevents levodopa being metabolised before reaching the brain

17
Q

Why is Levodopa not given first line?

A

Most effective treatment for symptoms

Less effective over time

18
Q

How is levodopa given?

A

As a combination drug e.g.

Co-beneldopa (levodopa and benserazie)
Co-careledopa (levodopa and carbidopa)

19
Q

What are the main side effects of levodopa?

A
  • Dyskinesia
  • Dystonia
  • Chorea
  • Athetosis
20
Q

What can be given to manage dyskinesia associated with levodopa?

A

Amantadine

Glutamate antagonist

21
Q

What are COMT inhibitors?

A

Inhibitors of catechol-o-methyltransferase that extend the effective duration of levodopa

Slows levodopa breakdown

22
Q

What do dopamine agonists do?

A

Mimic the action of dopamine in the basal ganglia, stimulating dopamine receptors

Less effective than levodopa

Used to delay use of levodopa, typically then used in combination

23
Q

What is a significant side effect of prolonged dopamine agonist use?

A

Pulmonary fibrosis

e.g. Bromocriptine
Pergolide
Cabergoline

24
Q

What is the function of monoamine oxidase-B inhibitors?

A

Block monoamine oxidase-B enzymes to increase circulating dopamine

e.g. Selegiline
Rasagiline

Year 4 - Neurology and Special Senses (41 decks)

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