Parkinson's

Question 1

Parkinsonism is a clinical syndrome with two or more of the following symptoms:

Answer 1

Bradykinesia (slowness of movement)
Rigidity
Tremor
Postural instability

Question 2

In terms of pathology, loss of what is involved in developing Parkinson’s?

Answer 2

Loss of dopamine

Question 3

Which type of dementia is idiopathic Parkinson’s similar to?

Answer 3

Dementia with Lewy bodies

Question 4

What would idiopathic Parkinson’s present with?

Answer 4

Prominent motor features
Late cognitive failure
Dementia

Question 5

What is the difference between Idiopathic Parkinson’s and dementia with Ley bodies?

Answer 5

Parkinson’s- late cognitive failure, prominent motor features
Dementia w Lewy bodies- early dementia, mild motor features

Question 6

Parkinson’s can be drug induced. Which drug?

Answer 6

Dopamine antagonists

Question 7

Which part of the body is affected more in Vascular Parkinsonism?

Answer 7

Lower half of body

Question 8

Parkinson’s plus syndromes are neurodegenerative disorders which have additional atypical features to distinguish them from idiopathic Parkinson’s.
What are these additional symptoms?

Answer 8

Multiple system atrophy (rapid progression, early falls and servere autonomic failure)
Progressive supranuclear palsy
Corticobasal degeneration

Question 9

Is Parkinson’s more common in men or women?

Answer 9

Men

Question 10

What are some risk factors of Parkinson’s?

Answer 10

Genetic
Environmental- pesticides, smoking, caffeine

Question 11

Name an autosomal dominant gene which causes Parkinson’s.

Answer 11

LRRK2
-> gives late onset of Parkinson’s

Question 12

Which gene is recessive and gives a much younger onset of Parkinson’s?

Answer 12

Parkin

Question 13

What is the only way to definitively diagnose Parkinson’s?

Answer 13

Similar to dementia, only way is through post-mortem examination

Question 14

What may be observed in a patient with Parkinson’s?

Answer 14

Asymmetric rest tremor

Question 15

What are some of the non-motor symptoms of Parkinson’s?

Answer 15

Anosmia- loss of smell
REM sleep behaviour disorder
Constipation, urinary/bowel incontinence
Hallucinations
Depression, fatigue, pain

Question 16

In Grade 1 and 2 Parkinson’s, where is there loss of dopaminergic cells?

Answer 16

Putamen

Question 17

In Grade 3 of Parkinson’s, where is there loss of dopaminergic cells?

Answer 17

Caudate

Question 18

Which scan is useful in showing the degenerative causes of Parkinsonism in terms of looking at the putamen and caudate?

Answer 18

SPECT

Question 19

What is the aim of Parkinson’s treatment?

Answer 19

To increase dopaminergic function

Question 20

RECAP FROM NEURO PHARMACOLOGY LECTURES- which drug is given to replace some of the missing dopamine and how does it do this?

Answer 20

Levodopa- crosses BBB and is converted to dopamine

Question 21

RECAP FROM NEURO PHARMACOLOGY LECTURES- which drug is given to prevent the breakdown of levodopa to prolong it’s action?

Answer 21

COMT inhibitor

Question 22

Give some examples of COMT inhibitors.

Answer 22

Entacapone
Tolcapone
Opicapone

Question 23

Dopamine agonists can stimulate dopamine receptors. Give some examples of dopamine agonists.

Answer 23

Ropinirole
Pramipexole
Rotigotine

Question 24

MOAB inhibitors prevent the breakdown of dopamine. Give some examples of these drugs.

Answer 24

Selegline
Rasagiline
Safinamide

Question 25

What are some drug-induced complications of Parkinson’s?

Answer 25

Motor fluctuations
Dyskinesia- involuntary movements
Psychiatric e.g. hallucinations, impulse control

Question 26

What are some general complications of Parkinson’s?

Answer 26

Balance-> falls, fractures
Dementia
Speech and swallowing
Gait freezing

Question 27

Why do people get drug-induced complications in Parkinson’s?

Answer 27

Levodopa wears off with time and patients notice effectiveness reduces before next dose is due

Question 28

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?

Answer 28

Men- gambling or hypersexuality
Women- compulsive shopping or binge eating

Question 29

Which drugs can be given to prolong the levodopa half life?

Answer 29

MOAB inhibitors
COMT inhibitors
Slow release levodopa

Question 30

What is the potential surgical option for treatment of motor complications?

Answer 30

Function neurosurgery - deep brain simulation