Parkinson disease Flashcards
what are the cardinal clinical features of parkinson disease? which is usually the initial presenting feature?
- tremor
- bradykinesia
- rigidity
- postural instability
- tremor
if a tremor is present during sleep, is that PD?
no
what is usually the most disabling feature of PD?
bradykinesia
rigidity is assessed based on resistance to ___________
passive ROM
what feature of PD accounts for the falls / fractures?
postural instability
what are the autonomic dysfunctions associated with PD?
- postural hypotension
- hyperhydrosis
- bowel / bladder
dementia is present in what % of PD patients? does it usually present earlier or later?
- 20-80%
- later (if early, PD is not the diagnosis)
what is the pathology in PD?
- degeneration of basal ganglia, locus ceruleus, vagal nerve nucleus
- zona compacta of substantia nigra
- loss of dopaminergic neurons
what are lewy bodies? where are they seen in excess in PD?
- eosinophilic cytoplasmic inclusion bodies
- zona compata
are lewy bodies seen in patients with essential tremor?
no
what protein is seen in lewy bodies?
ubiquitin
what are secondary causes of parkinsonism?
- post encephalitis
- drug induced
- toxin induced
- post traumatic
- NPH
- brain tumor
- multiple strokes
- wilsons disease
- HIV
what are the degenerative causes of parkinsonism?
- HD
- spinocerebellar degen
- striatonigral degen
- progressive supranuclear palsy
- LBD
- shy-drager syndrome / MSA
- AD
which drug is highly associated with parkinsonism?
metoclopramide
what is the MOA of metoclopramide?
irreversibly binds in post synaptic membrane, preventing action of DA across synapse
which drug types cause parkinsonism?
- DA receptor blockers (antipsychotics, anticonvulsant, antiemetic, GI motility)
- DA depleting drugs (anti HTN)
what toxins are associated with parkinsonism?
- CO
- manganese
- MPTP
- methanol / ethanol
NPH is characterized by what triad of features?
- cognitive dysfunction / lethargy
- gait disorder
- urinary incontinence
how is NPH diagnosed?
- H&P
- neuro imaging studies
- LP
what is the pathology in HD?
atrophy of the caudate nucleus
what are the inclusion criteria for PD?
- bradykinesia
- muscular rigidity
- postural instability
- *all 3 prove PD
- *2/3 are suggestive
what are the PD supportive criteria?
- unilateral onset
- resting tremor
- progressive disorder
- excellent response to LDOPA
- clinical course over 10 years
can you make a diagnosis for PD based on response to treatment?
NO
what are the PD exclusion criteria?
- history of repeated stroked, head trauma, encephalitis
- oculogyric crisis
- neuroleptic treatment at onset
- more than one affected relative
- sustained remission
- unilateral disease over 3 years
- supranuclear gaze palsy
- cerebellar signs
- early autonomic dysfunction
- early dementia
- babinski sign
- cerebral tumor / hydrocephalus
- no response to LDOPA
- MPTP exposure
