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Parkinson Flashcards

1
Q

Def

A

neurodegenerative condition that involves the progressive depletion of dopaminergic neurons in the basal ganglia, particularly the substantia nigra

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2
Q

Parkinsonism

A

syndrome that comprises bradykinesia along with resting tremor and/or rigidity

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3
Q

secondary parkinsonism

A

Parkinsonism that results from medication, intoxication, or traumatic brain injury

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4
Q

atypical parkinsonism

A

Or parkinson Plus syndromes
Parkinsonism due to neurodegenerative disorders other than PD is called atypical parkinsonism and manifests with features that are not characteristic of PD, such as
A) vertical gaze palsy in progressive supranuclear palsy and
B) apraxia and agnosia in corticobasal degeneration.
When doesn’t respond to tx, if dementia progresses rapidly or when early occurence of gait instability

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5
Q

progressive supranuclear palsy

A
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6
Q

Apraxia

A
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7
Q

agnosia

A
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8
Q

corticobasal degeneration

A
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9
Q

Genetic factors

A

α-Synuclein (SNCA)
• Glucocerebrosidase (GBA) gaucher – m/c
• Dardarin (LRRK2): A mutation in LRRK2 gene is the most common cause of dominantly inherited PD.
• Parkin (PARK2): A mutation in PARK2 gene is the most common cause of recessively inherited PD.

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10
Q

Secondary induced parkinsonism (drug-induced parkinsonism or pseudoparkinsonism)

A

• antidopaminergic effects: typical antipsychotics(e.g., haloperidol), some antiemetics (e.g., metoclopramide), some calcium channel blockers (e.g., flunarizine), amiodarone, valproate, and lithium [3][4]
• MPTP: an illegal drug that metabolizes to MPP+, damaging the substantia nigra
• Wilson disease, hemochromatosis, Niemann-Pick disease
• vascular parkinsonism: subcortical arteriosclerotic encephalopathy
• CNS infections (HSV, HIV, TB, Treponema, Toxoplasma, Plasmodium
Toxins: e.g., manganese, carbon monoxide, carbon disulfide

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11
Q

Preclinical stage

A

Constipation
Anosmia
Sleep disturbances
-REM sleep behavior disorder (RBD)
-Restless leg syndrome
-Excessive daytime sleepiness
Mood disorders (most commonly depression, apathy, and/or anxiety)

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12
Q

Tests

A

Pull test (instability)
Froment maneuver (repetitive movements eg. Opening-closing the fist - rigidity)

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13
Q

Signs in PD (motor)

A

Bradykinesia: slowed movements in combination with decreased amplitude/speed when moving
Resting tremor (4–6 Hz)
Rigidity
Instability, falls
shuffling gait with quickened and shortened steps
-Freezing: sudden inability to start or continue movements
-Festination: gait pattern characterized by small, increasingly quick steps
-Propulsion: forward-leaning gait with a risk of a patient falling forward
-Decreased arm swing
Unhabituated glabellar reflex
Signs of dystonia
Stooped posture
Abnormal flexor posturing of hands and feet (i.e., striatal deformities)
Micrographia: size of handwriting is reduced
Hypomimia: low degree of facial expression

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14
Q

Nonmotor signs

A

Autonomic symptoms

Orthostatic hypotension
Oily skin
Urinary urgency
Impaired sexual function

Neuropsychiatric symptoms
Depression
Cognitive problems, e.g., decreased attention and concentration, executive dysfunction, impaired memory (Parkinson dementia): develop in advanced disease [5]
Apathy
Behavioral changes (e.g., irritability, impulsivity)

Disordered sleep (sleep fragmentation, vivid dreams)
Fatigue
Hyposmia, anosmia

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15
Q

Dx

A

Parkinson disease is a clinical diagnosis. A definitive diagnosis requires postmortem confirmation of Lewy bodies.

Supportive features include:
Clear benefit from dopaminergic medication
Resting tremor
Levodopa-induced dyskinesia (typically occurs during later stages of PD - tics, involuntary movements, twitching)
Olfactory loss

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16
Q

Lewy bodies

A

Aggregates of misfolded α-synuclein and other proteins, such as ubiquitin and neurofilament protein within the neural cell bodies
May be found in brainstem, substantia nigra, and cortex

17
Q

Carbidopa

A

decarboxylase inhibitor

18
Q

Honeymoon period

A

beneficial effect in early phase of treatment with L-DOPA

19
Q

Nonergot dopamine receptor agonists

A

In younger Pt

Pramipexole

Ropinirole

Apomorphine

20
Q

MAO i

A

Selegiline
Rasagiline

21
Q

Anti ACh

A

Benztropine
Trihexyphenidyl

22
Q

COMT inhibitors

A

Entacapone

23
Q

Amantadine

A

NMDA antagonist

24
Q

Deep brain stimulation (DBS

A

Stereotactic implantation of stimulating electrode(s) targeting the subthalamic nucleus or internal globus pallidus

25
Q

DDX

A

Vascular parkinsonism
Multiple system atrophy Progressive supranuclear palsy
Corticobasal degeneration

26
Q

Vascular parkinsonism

A

> 70yo
Symmetric , Limited to lower limbs
Starts with Gait impairment
Spasticity, w/o tremor
Multiple periventricular lesions
Lacunar infarcts in the basal ganglia
Cognitive impairment

27
Q

Multiple system atrophy

A

50y/o
progressive degeneration of neurons in several parts of the brain including the basal ganglia, striatum, inferior olivary nucleus, and cerebellum.
Symetric
Starts with Autonomic dysfunction (e.g., postprandial hypotension, anhidrosis, erectile dysfunction in men)
Rigidity>spacticity
Instability
Hypermetric saccades
Vestibuloocular reflex suppression
Early dysarthria and dysphonia

parkinsonism (muscle rigidity +/ tremor and slow movement: MSA-P)
cerebellar ataxia (Poor coordination/unsteady walking: MSA-C)
MSA-P: predominantly parkinsonian features (previously referred to as striatonigral degeneration)
MSA-C: predominantly cerebellar features (previously referred to as olivopontocerebellar atrophy)
MRI: hot cross bun sign

28
Q

PSP

A

Starts with Postural instability with falls
Axial rigidity
Vertical supranuclear gaze palsy
Decreased velocity of saccades
Square wave jerks
Reduced blinking
Pseudobulbar palsy is common

Apraxia of eyelid opening
Procerus sign: deep vertical wrinkles at the base of the eyebrows
Neuropsychiatric symptoms (depression, dementia, sleep disorders)
Asymmetric cortical atrophy (parietal is most prominent)
Hummingbird sign

29
Q

Corticobasal degeneration

A

50-70 yo
Assymetric
Upper limb clumsiness (apraxia) and bradykinesia
Rigidity
Alien limb phenomenon
Ideomotor apraxia
Aphasia
Rest and/or induced myoclonus

30
Q

Parkinson-plus syndromes

A

Dementia with Lewy bodies
Multiple system atrophy
Progressive supranuclear palsy
Corticobasal degeneration

31
Q

P+ features

A

Poor response to levodopa
Dementia
Early involvement of the autonomic nervous system, including:
Orthostatic hypotension
Impotence
Incontinence
Anhidrosis
Early onset of postural instability with frequent falls
Visual hallucinations
Signs of cerebellar involvement
Presence of pathological reflexes, such as:
Babinski sign
Enhanced proprioceptive reflexes
Eating and swallowing disorders
Pronounced dysarthria
Supranuclear vertical gaze palsy
Apraxia

32
Q

Dementia with Lewy bodies

A

Lewy body dementia if the onset of both cognitive and motor symptoms is within 1 year
Dementia secondary to Parkinson disease if cognitive symptoms occur > 1 year after the onset of motor symptoms

Cerebral atrophy, particularly of the frontal lobe
Relative sparing of the hippocampi
Lewy bodies in cortical
Dementia + parkinsonism, visual hallucinations, cognitive impairment, falls, psychotic symptoms

Neuro (12 decks)

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