Parkinson Disease Flashcards
What are some causes of sudden declines in PD symptoms?
Not taking meds
Intercurrent illness - eg UTI
Dehydration
Poor nutrition
Deconditioning
What are the advanced therapies for PD?
Apomorphine infusion (dopamine agonist)
Deep brain stimulation - stimulate the globus pallidus or subthalamic nucleus
What is the main difference between dementia with Lewy bodies and Parkinson disease?
The dementia preceeds the movement disorder in DLB, in Parkinson disease the movement disorder occurs first
What is restless legs?
Deep noring pain in the legs at night that is relieved by movement
What is the purpose of a decarboxylase inhibitor?
Stops metabolism of levedopa in the periphery to prevent side effects
What happens to the eyes in PD?
Reduced blink rate
Hypometric saccades
Saccadic intrusion into smooth pursuit
What the incidence of Parkinson disease?
100-200 per 100,000 over 40 years
How long might anosmia preceed the movement symptoms?
15-20 years
What is the pathology of PD?
Loss of dopaminergic neuron in the substantia nigra, therefore dopamine production, in the basal ganglia
What are some causes of PD or PD like syndrome?
Genetic
Brain injury
Pesticide exposure
What does a festinating gait look like?
Difficult to initiate walking
Increasing speed of steps
+/- Fall
How does the levodopa regimen change with the progression of the disease?
Increase dose frequency as endogenous dopamine production decreases so they have exogenous dopamine most of the time
What is the ratio of male to female in the incidence of Parkinson disease?
3:2
What is the first line therapy for PD?
Levedopa
What are some nocturnal symptoms of PD?
Enacting their dreams in bed
Restless legs
Reduced turning in bed
What does tremor predominant PD refer to? What are the implications?
Predominance of tremor at presentation, usually slower progression of disease
What is the Hoen-Yhaer staging?
Staging for PD severity
Uses the pull test
What anti-emetic is levodopa accompanied with?
Domperidone
Can PD be diagnosed without a tremor?
Yes
What does asymmetry of motor sign indicate?
More likely PD than an other cause of Parkinsonism
What is the side effect of levodopa?
Dyskinesia
Nausea
What is the most effective intervention for improved walking and falls prevention?
Physio
Exercises requiring balance
What is the name of the facial affect PD patient might exhibit?
Hypomimia
Blank face
What is madopar?
Levodopa and benserazide
What are some other PD medications?
COMT inhibitors
Selective monoamine oxidase type B inhibitors
Dopamine agonists (pramipexole)
Anticholinergic
Amantadine
What are the cardinal feature of PD?
Tremor
Rigidity
Bradykinesia
Postural instability
What is the mean age of diagnosis?
Around 70
What is the main symptomatic relief provided by levodopa?
Reduced bradykinesia
What causes acute akinesia in PD?
Not taking their medication
Intercurrent illness
How does speech change in PD?
Lower volume
What is dystonia?
Involuntary muscle contraction involving abnormal movements and postures
What is dystonia is the setting of PD likely due to?
Drugs
What is the difference between GEM and Fast track?
GEM is slow stream for the less motivated patient
Fast track is for the highly motivated patient
What are the features of a PD gait?
Shuffling +/- festinating/freezing
Brady and hypokinetic
Camptocormia (stooped posture)
Loss of arm swing
Increase in tremor
Difficult crossing threshold
Slow turning
What is the pull test?
When the patient is pulled back they take multiple steps (instead of one)
What are the most troubesome non-motor features of PD?
Orthostatic hypotension
Urinary frequency
Constipation
What are the side effects of dopamine agonists?
Hypersexuality
Gambling
Binge eating
Shopping
An increase in tremor when walking indicates what?
PD is most likely over other movement disorders
How does dementia develop in PD?
It develops after movement symptoms in all PD patients
What is the prevalence of depression in PD patients? How it is treated?
40%
Treat with SSRI
What is on-off syndrome?
Episodes of decreased mobility despite medications
Can prepitate failure to turn “on” if for a prolonged period
