Parkinson's Flashcards
Parkinsonism is a clinical syndrome with two or more of the following symptoms:
Bradykinesia (slowness of movement)
Rigidity
Tremor
Postural instability
In terms of pathology, loss of what is involved in developing Parkinson’s?
Loss of dopamine
Which type of dementia is idiopathic Parkinson’s similar to?
Dementia with Lewy bodies
What would idiopathic Parkinson’s present with?
Prominent motor features
Late cognitive failure
Dementia
What is the difference between Idiopathic Parkinson’s and dementia with Ley bodies?
Parkinson’s- late cognitive failure, prominent motor features
Dementia w Lewy bodies- early dementia, mild motor features
Parkinson’s can be drug induced. Which drug?
Dopamine antagonists
Which part of the body is affected more in Vascular Parkinsonism?
Lower half of body
Parkinson’s plus syndromes are neurodegenerative disorders which have additional atypical features to distinguish them from idiopathic Parkinson’s.
What are these additional symptoms?
Multiple system atrophy (rapid progression, early falls and servere autonomic failure)
Progressive supranuclear palsy
Corticobasal degeneration
Is Parkinson’s more common in men or women?
Men
What are some risk factors of Parkinson’s?
Genetic
Environmental- pesticides, smoking, caffeine
Name an autosomal dominant gene which causes Parkinson’s.
LRRK2
-> gives late onset of Parkinson’s
Which gene is recessive and gives a much younger onset of Parkinson’s?
Parkin
What is the only way to definitively diagnose Parkinson’s?
Similar to dementia, only way is through post-mortem examination
What may be observed in a patient with Parkinson’s?
Asymmetric rest tremor
What are some of the non-motor symptoms of Parkinson’s?
Anosmia- loss of smell
REM sleep behaviour disorder
Constipation, urinary/bowel incontinence
Hallucinations
Depression, fatigue, pain
In Grade 1 and 2 Parkinson’s, where is there loss of dopaminergic cells?
Putamen
In Grade 3 of Parkinson’s, where is there loss of dopaminergic cells?
Caudate
Which scan is useful in showing the degenerative causes of Parkinsonism in terms of looking at the putamen and caudate?
SPECT
What is the aim of Parkinson’s treatment?
To increase dopaminergic function
RECAP FROM NEURO PHARMACOLOGY LECTURES- which drug is given to replace some of the missing dopamine and how does it do this?
Levodopa- crosses BBB and is converted to dopamine
RECAP FROM NEURO PHARMACOLOGY LECTURES- which drug is given to prevent the breakdown of levodopa to prolong it’s action?
COMT inhibitor
Give some examples of COMT inhibitors.
Entacapone
Tolcapone
Opicapone
Dopamine agonists can stimulate dopamine receptors. Give some examples of dopamine agonists.
Ropinirole
Pramipexole
Rotigotine
MOAB inhibitors prevent the breakdown of dopamine. Give some examples of these drugs.
Selegline
Rasagiline
Safinamide
What are some drug-induced complications of Parkinson’s?
Motor fluctuations
Dyskinesia- involuntary movements
Psychiatric e.g. hallucinations, impulse control
What are some general complications of Parkinson’s?
Balance-> falls, fractures
Dementia
Speech and swallowing
Gait freezing
Why do people get drug-induced complications in Parkinson’s?
Levodopa wears off with time and patients notice effectiveness reduces before next dose is due
As previously mentioned, impulse control can be one of the drug-induced complications in Parkinson’s. What can this look like in men and women?
Men- gambling or hypersexuality
Women- compulsive shopping or binge eating
Which drugs can be given to prolong the levodopa half life?
MOAB inhibitors
COMT inhibitors
Slow release levodopa
What is the potential surgical option for treatment of motor complications?
Function neurosurgery - deep brain simulation
