Parkinson disease

Question 1

Levodopa-induced dyskinesia

Answer 1

Movements include: chorea, ballism, dystonia, myoclonus, or cmmbination

1. ) peak dose dyskinesia
2. ) Wearing off dyskinesia
3. ) diphasic dyskinesia
   - begins after levodopa ingestion, followed by improvement of parkinsonian symptoms and dyskinesias, then RETURN of dyskinesias as dopamine levels decline

Question 2

Clinical progression

Answer 2

1. ) preclinical phase:
   - neurodegeneration begins but lacks symptoms
2. ) prodromal phase:
   - symptoms are present but insufficient to diagnose the disease
3. ) clinical phase:
   - parkinsonian symptoms are present and recognizable

Question 3

Red flags for atypical parkinsonisms (previously known as Parkinson-plus syndromes)

Answer 3

• early speech difficulties
• imbalance
• lack of tremor
• symmetry of symptoms
• poor response to levodopa
• dysautonimia
• supranuclear gaze palsy
• marked asymmetry/dystonia with cortical findings

Atypical Parkinonsims:

1. ) MSA
2. ) PSP
3. ) Dementia Lewy body
4. ) Corticobasal degeneration

Question 4

Genetics of PD

Answer 4

5-10%

1. ) PARK-SNCA
2. ) PARK-LRRK2
3. ) PARK-VPS35

Ashkenazi Jewish population, GBA1 (gene responsible for Gaucher disease)

• GBA1 directs production of GLUCOCEREBROSIDASE (involved in lysosomal activity)
• genetic defect causes reduction in this glucocerebrosidase activity, increase in glucosylceramide, and accumulation of alpha-synuclein

Question 5

Parkinson Clinical rating scale

Answer 5

Unified Parkison disease Rating scale

1. ) cognition and mood
2. ) ADLs
3. ) Motor examination
4. ) Motor complications

The Hoehn and Yahr Scale

1. ) unilateral symptoms
2. ) bilateral symptoms
3. ) postural instability with worsening bilateral symtpoms
4. ) worsening symptoms with inability to live alone or independently
5. ) wheelchair or bed assistance

Question 6

Parkinson Disease Dementia-Clinical Diagnostic Criteria

Answer 6

A.) Clinical features, Core (both present)
1.) Bradykinesia, + one of following: TRA(bradykinesia/akinesia)P

a.) at least 3 supportive criteria: unilateral onset and persistent asymmetry, progressive, responsive to L-dopa (at least 5 years), L-dopa induced chorea, hyposmia, visual hallucinations

2. )Dementia syndrome, insidious onset, slow prgoression, developing in context of PDD
   a. ) impairment in more than one cognitive domain
   b. ) decline from premorbid level
   c. ) deficits severe enough to impair ADLs.

Question 7

DLB-Probable

Answer 7

> 2 or more core clinical features (with/without indicative biomarkers)

OR

1 core feature with one or more indicative biomarker

DEMENTIA IS ESSENTIAL TO DIAGNOSE DLB-

a. ) progressive cognitive decline
b. ) interfere with ADLs
c. ) deficits on tests of attention, executive function, and visuoperceptual ability may be prominent; memory impairment may not present early

📗CORE:
a.) Fluctuating cognition with pronounced variations in attention and alertness

b. ) Recurrent visual hallucinations that are typically well formed and detailed
c. ) REM sleep behavior disorder, which may precede cognitive decline
d. ) One or more spontaneous cardinal features of parkinsonism (bradykinesia, rest tremor, rigidity)

📙Indicative Biomarkers:
a.) Reduced dopamine transporter uptake in basal ganglia by SPECT or PET

b. ) Abnormal (low-uptake) 123iodine-MIBG myocardial scintigraphy
c. ) Polysomnographic confirmation of REM sleep without atonia

**CT/MRI: relative preservation of MTL (AD has increased MTL atrophy)