Parkinson Disease

Question 1

What are some causes of sudden declines in PD symptoms?

Answer 1

Not taking meds

Intercurrent illness - eg UTI

Dehydration

Poor nutrition

Deconditioning

Question 2

What are the advanced therapies for PD?

Answer 2

Apomorphine infusion (dopamine agonist)

Deep brain stimulation - stimulate the globus pallidus or subthalamic nucleus

Question 3

What is the main difference between dementia with Lewy bodies and Parkinson disease?

Answer 3

The dementia preceeds the movement disorder in DLB, in Parkinson disease the movement disorder occurs first

Question 4

What is restless legs?

Answer 4

Deep noring pain in the legs at night that is relieved by movement

Question 5

What is the purpose of a decarboxylase inhibitor?

Answer 5

Stops metabolism of levedopa in the periphery to prevent side effects

Question 6

What happens to the eyes in PD?

Answer 6

Reduced blink rate

Hypometric saccades

Saccadic intrusion into smooth pursuit

Question 7

What the incidence of Parkinson disease?

Answer 7

100-200 per 100,000 over 40 years

Question 8

How long might anosmia preceed the movement symptoms?

Answer 8

15-20 years

Question 9

What is the pathology of PD?

Answer 9

Loss of dopaminergic neuron in the substantia nigra, therefore dopamine production, in the basal ganglia

Question 10

What are some causes of PD or PD like syndrome?

Answer 10

Genetic

Brain injury

Pesticide exposure

Question 11

What does a festinating gait look like?

Answer 11

Difficult to initiate walking

Increasing speed of steps

+/- Fall

Question 12

How does the levodopa regimen change with the progression of the disease?

Answer 12

Increase dose frequency as endogenous dopamine production decreases so they have exogenous dopamine most of the time

Question 13

What is the ratio of male to female in the incidence of Parkinson disease?

Answer 13

3:2

Question 14

What is the first line therapy for PD?

Answer 14

Levedopa

Question 15

What are some nocturnal symptoms of PD?

Answer 15

Enacting their dreams in bed

Restless legs

Reduced turning in bed

Question 16

What does tremor predominant PD refer to? What are the implications?

Answer 16

Predominance of tremor at presentation, usually slower progression of disease

Question 17

What is the Hoen-Yhaer staging?

Answer 17

Staging for PD severity

Uses the pull test

Question 18

What anti-emetic is levodopa accompanied with?

Answer 18

Domperidone

Question 19

Can PD be diagnosed without a tremor?

Answer 19

Yes

Question 20

What does asymmetry of motor sign indicate?

Answer 20

More likely PD than an other cause of Parkinsonism

Question 21

What is the side effect of levodopa?

Answer 21

Dyskinesia

Nausea

Question 22

What is the most effective intervention for improved walking and falls prevention?

Answer 22

Physio

Exercises requiring balance

Question 23

What is the name of the facial affect PD patient might exhibit?

Answer 23

Hypomimia

Blank face

Question 24

What is madopar?

Answer 24

Levodopa and benserazide

Question 25

What are some other PD medications?

Answer 25

COMT inhibitors Selective monoamine oxidase type B inhibitors Dopamine agonists (pramipexole) Anticholinergic Amantadine

Question 26

What are the cardinal feature of PD?

Answer 26

Tremor Rigidity Bradykinesia Postural instability

Question 27

What is the mean age of diagnosis?

Answer 27

Around 70

Question 28

What is the main symptomatic relief provided by levodopa?

Answer 28

Reduced bradykinesia

Question 29

What causes acute akinesia in PD?

Answer 29

Not taking their medication Intercurrent illness

Question 30

How does speech change in PD?

Answer 30

Lower volume

Question 31

What is dystonia?

Answer 31

Involuntary muscle contraction involving abnormal movements and postures

Question 32

What is dystonia is the setting of PD likely due to?

Answer 32

Drugs

Question 33

What is the difference between GEM and Fast track?

Answer 33

GEM is slow stream for the less motivated patient Fast track is for the highly motivated patient

Question 34

What are the features of a PD gait?

Answer 34

Shuffling +/- festinating/freezing Brady and hypokinetic Camptocormia (stooped posture) Loss of arm swing Increase in tremor Difficult crossing threshold Slow turning

Question 35

What is the pull test?

Answer 35

When the patient is pulled back they take multiple steps (instead of one)

Question 36

What are the most troubesome non-motor features of PD?

Answer 36

Orthostatic hypotension Urinary frequency Constipation

Question 37

What are the side effects of dopamine agonists?

Answer 37

Hypersexuality Gambling Binge eating Shopping

Question 38

An increase in tremor when walking indicates what?

Answer 38

PD is most likely over other movement disorders

Question 39

How does dementia develop in PD?

Answer 39

It develops after movement symptoms in all PD patients

Question 40

What is the prevalence of depression in PD patients? How it is treated?

Answer 40

40% Treat with SSRI

Question 42

What is on-off syndrome?

Answer 42

Episodes of decreased mobility despite medications Can prepitate failure to turn "on" if for a prolonged period