Parkinson disease

Question 1

describe parkinsons condition

Answer 1

Parkinson’s disease is a condition where there is a progressive reduction of dopamine in the basal ganglia of the brain, leading to disorders of movement

Question 2

parkinsons symptoms are …..

Answer 2

characteristically asymmetrical, with one side affected more than the other

Question 3

what is the classic triad of features parkinsons presents with?

Answer 3

There is a classic triad of features in Parkinson’s disease:

Resting tremor
Rigidity
Bradykinesia

Question 4

describe the pathophysiology of parkinsons disease

Answer 4

Basal ganglia - responsible for coordinating habitual movements such as walking or looking around, controlling voluntary movements and learning specific movement patterns
part of Basal ganglia its the substantial nigra - produce dopamine.
in PD, gradual and progressive fall in dopamine level

Question 5

describe the typical parkinsons patient

Answer 5

The typical patient is an older aged man around the age of 70.
stooped posture
facial masking
forward tilt
reduced arm swing
shuffling gait

Question 6

The tremor in Parkinsons has a frequency of …

Answer 6

The tremor in Parkinsons has a frequency of 4-6 Hz, meaning it occurs 4-6 times a second.

Question 7

descrie the unilateral temor in parkinsons

Answer 7

4-6 times / second
“pill rolling tremor”
more pronounced when resting, improved on voluntary movement
worsened when patient is distracted
Asking them to do a task with the other hand, such as miming the motion of painting a fence, can exaggerate the tremor.

Question 8

describe cogwheel rigidity

Answer 8

Rigidity is a resistance to passive movement of a joint. If you take their hand and passively flex and extend their arm at the elbow, you will feel a tension in their arm that gives way to movement in small increments (like little jerks). This is what leads to the cogwheel description.

Question 9

what is bradykinesia?

Answer 9

Bradykinesia describes how their movements get slower and smaller.

Question 10

how can Brady kinesis present?

Answer 10

Their handwriting gets smaller and smaller (this is a classic presenting complaint in exams)
They can only take small steps when walking (“shuffling gait”)
They have difficulty initiating movement (e.g. from standing still to walking)
They have difficulty in turning around when standing, having to take lots of little steps
They have reduced facial movements and facial expressions (hypomimia)

Question 11

Give some other features that often affect patients with parkinsons disease

Answer 11

Depression
Sleep disturbance and insomnia
Loss of the sense of smell (anosmia)
Postural instability
Cognitive impairment and memory problems

Question 12

how do you distinguish between Parkinsons tremor and Benign essential tremor?

Answer 12

A

Question 13

give 4 parkinsons plus syndromes?

Answer 13

Multiple system atrophy
Dementia with lewy bodies
Progressive supra nuclear palsy
corticobasal degeneration

Question 14

describe multiple system atrophy

Answer 14

rare
neurones of multiple systems in the brain degenerate
affects basal ganglia + multiple other areas
degen of basal ganglia = parkinsons presentation
degen of other areas = autonomic dysfunction ((causing postural hypotension, constipation, abnormal sweating and sexual dysfunction) and cerebellar dysfunction (causing ataxia)

Question 15

describe dementia with lewy bodies

Answer 15

type of dementia associated with features of Parkinsonism.
causes a progressive cognitive decline
associated symptoms of visual hallucinations, delusions, disorders of REM sleep, and fluctuating conciousness

Question 16

how do we diagnose parkinsons

Answer 16

Parkinson’s disease is diagnosed clinically based on symptoms and examination. The diagnosis should be made by a specialist with experience in diagnosing Parkinson’s. NICE recommend using the UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria.

Question 17

is there a cure for parkinsons?

Answer 17

no

Question 18

treatment for parkinsons is focussed on?

Answer 18

controlling symptoms and minimising side effects.

Question 19

describe what is meant by “on” and “off” in parkinsons patients?

Answer 19

Patients describe themselves as “on” when the medications are acting and they are moving freely, and “off” when the medications wear out, they have significant symptoms and their next dose is due.

Question 20

4 drugs used to control parkinsons?

Answer 20

Levodopa
COMT inhibitors
Dopamine Agonists
Monoamine Oxidase-B Inhibitors

Question 21

how is levodopa used to treat parkinsons?

Answer 21

oral synthetic dopamine
usually combined with a drug to stop it getting broken down before it reaches the brain (peripheral decarboxylase inhibitors - eg Carbidopa, benserazide)
most effective, but becomes less effective over time. often last resort.

Question 22

what are the side effects of levodopa?

Answer 22

The main side effect of dopamine is when the dose is too high patients develop dyskinesias. Theses are abnormal movements associated with excessive motor activity. Examples are:

Dystonia: This is where excessive muscle contraction leads to abnormal postures or exaggerated movements.
Chorea: These are abnormal involuntary movements that can be jerking and random.
Athetosis: These are involuntary twisting or writhing movements usually in the fingers, hands or feet.

Question 23

what is dystonia?

Answer 23

Dystonia: This is where excessive muscle contraction leads to abnormal postures or exaggerated movements.

Question 24

what is chorea

Answer 24

Chorea: These are abnormal involuntary movements that can be jerking and random.

Question 25

what is athetosis

Answer 25

Athetosis: These are involuntary twisting or writhing movements usually in the fingers, hands or feet.

Question 26

give an example of a COMT inhibitor

Answer 26

Entacapone

Question 27

how to COMT inhibitors manage parkinsons

Answer 27

These are inhibitors of catechol-o-methyltransferase (COMT). The COMT enzyme metabolises levodopa in both the body and brain. Entacapone is taken with levodopa (and a decarboxylase inhibitor) to slow breakdown of the levodopa in the brain. It extends the effective duration of the levodopa.

Question 28

how are dopamine agonists used to treat parkinsons?

Answer 28

These mimic dopamine in the basal ganglia and stimulate the dopamine receptors. They are less effective than levodopa in reducing symptoms. They are usually used to delay the use of levodopa and are then used in combination with levodopa to reduce the dose of levodopa that is required to control symptoms.

Question 29

what’s the notable side effect of dopamine agonists?

Answer 29

pulmonary fibrosis

Question 30

give some examples of dopamine agonists

Answer 30

Bromocryptine
Pergolide
Carbergoline

Question 31

what are Monoamine Oxidase-B Inhibitors - how do they treat parkinsons

Answer 31

Monoamine oxidase enzymes break down neurotransmitters such as dopamine, serotonin and adrenaline.
The monoamine oxidase-B enzyme is more specific to dopamine and does not act on serotonin or adrenalin.
These medications block this enzyme and therefore help increase the circulating dopamine

Question 32

how are Monoamine Oxidase-B Inhibitors used (at what stage) in parkinsons?

Answer 32

Similarly to dopamine agonists, they are usually used to delay the use of levodopa and then in combination with levodopa to reduce the required dose.

Question 33

give some examples of Monoamine Oxidase-B Inhibitors

Answer 33

Selegiline
Rasagiline