Parkinson's Flashcards
1
Q
Etiology
A
1. Sporadic Oxidative stress to dopaminergic neurons Toxins Accelerated ageing Genetics 2. Familial Alpha synuclei protein Parkin gene 3. MPTP neurotoxin
2
Q
Pathophysiology
A
- Loss of dopaminergic neurons in substantia nigra
- DIsinhibition of indirect pathway and decreased activation of direct pathway= increased inhibition of motor pathways
- Alpha synuclein accumulated in lewy bodies and causes neruotoxicity
3
Q
Epidemiology
A
- Mean age of onset is 65 years
4
Q
Risk factors
A
- Family history
- Male
- Head injury
- Exposure to neurotoxins
5
Q
Protective factors
A
- Coffee
- Smoking
- NSAID
- HRT in post=menopausal
6
Q
Clinical presentation
A
- Bradykinesia
- Rigidity
- Resting tremor
- Postural instability
- Shuffling gait
- Masked facies
- Hypophonia
- Monotonous speech
- Micrographia
- Cognition, behaviour
- Autonomic: constipation, urinary retention, sexual dysfunction, orthostatic hypotension
- REM sleep disorder
7
Q
Management
A
1. Multidisicplinary Neurologist Physiotherapist Nursing Occupational therapist GP Social worker Parkinsons QLD Inc for support and information 2. Assess disability 3. Medication L-dopa (Levodopa/Carbidopa) Dopamine agonist->Ropinirole and pramipexole, bromocriptine, pergolide, cabergoline Amantadine MAOI Anticholinergics->not in elderly COMT inhibitors Anticholinersterases->Rivastigmine Apomorphine 4. Neuropsychiatric 5. Respite 6. Surgery Surgical lesions Deep brain stimulation
8
Q
What are parkinson’s plus syndromes
A
1. Progressive supranuclear palsy Early postural instability Falls Vertical gaze palsy Rigidity of trunk > limbs 2. Multiple system atrophy (Shy Drager) Early autonomic symptoms Postural hypotension Bladder dysfunction Cerebellar and pyramidal signs Rigidity > tremor 3. Cortico-basal degeneration Akinetic degeneration involving one limb Sensory loss Apraxia 4. Lewy body dementia Visual hallucinations Fluctuating 5. Vascular parkinsonism Worse in legs than arms Pyramidal signs Prominent gait abnormality
9
Q
Counselling use of Levodopa
A
- Works to replace some of the DA no longer producing
- Help to reduce your symptoms->particularly the rigidity and bradykinesia (slow movem)
- Given with carbidopa to inhibit peripheral levodopa degeneratioin
- 3-4 times with food to reduce nausea/vomiting
- Taken for as long as effective, after 5 years there is end dose deterioration->works for shorter, on and off, fluctuating effect
- DevelopM of dyskinesia, painful dystonias and response fluctuations
- Fast acting medication
- Side effects
N/V->use domperidone
Psychosis
Dyskinesia
Postural hypotension
Other drugs can be used to help with the side effects - Contraindicated in glaucoma
10
Q
Criteria for diagnosis
A
- Bradykinesia + at least one of
- Muscular rigidity
- 4-6Hz rest tremor
- Postural instability not caused by visual/cerebellar dysfunction
It is unilateral onset, resting, progressive
70-100% response to levodopa
11
Q
Division of symptoms
A
1. Premotor REM sleep abnormalities Constipation Hyposomnia Depression 2. Motor 3. Non-motor Psychosis Cognitive->Alzheimers, LBD Sleep-wake
12
Q
Exclusion criteria
A
- Repeated strokes, head injury, encephalitis
- Neuroleptic treatment at onset of symptoms
- Poor response to levodopa->MSA, SNP
- Essential tremor
- Early, severe dementia
- Cerebral tumor or hydrocephalus on CT
- MPTP exposure
