parkinson's

Question 1

what is parkinson’s disease

Answer 1

progressive neurodegenerative disorder
starts slowly and progresses gradually
brain cells are lost due to abnormal protein aggregation (a-synuclein), mitochondrial dysfunction
dopaminergic cells in the brain (substantia nigra), other monoaminergic cells in brainstem
2nd most common neurodegenerative disorder after alzheimers disease

Question 2

parkinson’s dsease is primarily caused by

Answer 2

loss of dopaminergic cells in the brain (substantia nigra), other monoaminergic cells in the brainstem also lost

Question 3

cardinal features of parkinson’s disease

Answer 3

bradykinesia 
tremor 
rest 
posture and action 
regidity 
postural reflex impairment

Question 4

pathogenesis of parkinson’s disease

Answer 4

toxic processes - oxidative stress, mitochodnrial dysfunction, toxins

gene mutations - a-synuclein, parkin

susceptibility - decreased expression of UPS components (age related), decreased UPS activity

leads to ubiquitin dependant proteasomal proteolysis system failure

Question 5

staging of PD

Answer 5

stage 1 - dorsal motor nucleus of the vagal nerve, anterior olfactory structures
stage 2 - lower raphe nuclei, locus coeruleus
stage 3 - substantia nigra; anygdala; nucleus basilis of Maynert (clinical diagnosis)
stage 4 temporal mesocortex
stage 5 - temporral neocortex; sensory association and premotor areas
stage 6 - neocortex; primary sensory and motor areas

Question 6

diagnosis of PD

Answer 6

mainly clinical - hisstory and examination
tests to rulle out other causes
- MRI scan of the brain
- metabolic/genetic testing in children/young adults
special tests if necesary
- DOPA PET, dopamine transporter scans
- MIBG heart scan

Question 7

DAT scan

Answer 7

dopaminergic transporter scan

Question 8

secondary parkinson’s

Answer 8

drugs, toxins, stroke, infections, head injury

Question 9

parkinson-like tremors

Answer 9

essential tremork dystonic tremor

tremor due to drugs

Question 10

symptoms of PD

Answer 10

motor (asymmetrical) 
- tremor, rigidity, bradykinesia
- posture, gait, balance 
- micrographia, hypophonia, facial expression 
non-motor 
- olfactory, RBD
- blood pressure, bladder, bowel, swallowing
- fatigue, pain, sleep
- attention, concentration, memory 
- mood, psychosis

Question 11

prognosis of PD

Answer 11

most people with PD can live relatively normal lives in the first 5-10 years, many for over 15-20 years
life expectancy is reduced by up to 10%
disability in later stags

Question 12

what responds best to drugs

Answer 12

rigidity and bradykinesia

tremor and gait

Question 13

what does not respond optimally to drugs

Answer 13

balance, gait freezing

Question 14

classes of drugs for parkinsons

Answer 14

L-Dopa
dopamine agonists
MAO-B inhibitors
amantadine, anticholinergics

Question 15

L DOPA metabolism

Answer 15

converted to dopamine in the brain
prevented from turning into dopamine in the blood
MAO and COMT break down dopamine

Question 16

non motor symptoms for parkinons

Answer 16

constipation 
urinary urgency and urge incontinence 
cognitive decline
psychosis, hallucinations, paranoia 
anxiety and depression 
pain and fatigue 
insomnia, daytime, sleepiness

Question 17

advrse effects of L DOPA

Answer 17

nausea, vomiting
dykinesia, motor fluctuation
dopamine dysregulation syndrome

Question 18

adverse effects of dopamine agonists

Answer 18

impulse control disorders, punding

sleepiness, pedal oedema

Question 19

adverse effects of all dopaminergic drugs

Answer 19

postural hypotension, hallucinations

Question 20

adverse effects of amentadine

Answer 20

confuson, leg swelling, livido-reticularis

Question 21

drugs than worsen symptoms in parkinson’s disease

Answer 21

antipsychotics
antiemetics
antihistamines
DDIs - selegeline and certain antidepressants

Question 22

surgery and parkinsons disease

Answer 22

PD is not a contraindication for any ssurgery or procedures
concern usually due to oral medictaion stoppage
no oral intake for any reason

Question 23

missing medication doses in PD

Answer 23

ok to miss 1 or 2 doses but more prologed periods without medications can worsen PD symptoms (and cause freezing)

Question 24

exercise for PD

Answer 24

maintains abilities 
strengthne muscles 
increase mobility in joints 
build up general fitness and health 
provides sense of achievemnt 
reduces feelings of sstress, anxiety and depression

Question 25

motor fluctuations

Answer 25

motor fluctaution, L-dopa induced dyskinesia, dystonia

releated to L DOPA and progression of disease

Question 26

continuous dopaminergic stimulation

Answer 26

too releive motor flucuations
subcutaneous apo-morphine infusion 
duodopa therapy 
deep brain stimulation (DBS) 
focused ultrasound

Question 27

deep brain stimulation

Answer 27

DBS
improvement of bradykinesia and rigidity, tremor
reduced levodopa induced dyskinesia
improvement in quality of life
improvement in bladder symptoms, sleep, constipation

Question 28

adverse effects of DBS

Answer 28

cognitive
mood - depression, hypomania, apathy 
weight gain 
dysarthria 
balance and falls 
eyelid opening apraxia

Question 29

late stage PD

Answer 29

relentlessly progresssive
within 15-20 years of disease onset mortality is 2-3 x the general population
currently no disease modifying treatment - unmet need in PD and most other neurodegenerative disorders

Question 30

treatment resistant problems

Answer 30

postural instability and falls 
speech and swalloing dyfunction 
autonomic symptoms 
psychosis 
dementia

Question 31

potential for disease modifying treatment

Answer 31

neuroprrotective drugs
stem cells
growth factors
gene therapy