Parkinson's

Question 1

number one risk factor for Parkinson’s

Answer 1

aging 2-4% risk >60 years

Question 2

do males or females get Parkinson’s more

Answer 2

Males 3:2 (M:F)

Question 3

etiology of Parkinson’s

Answer 3

idiopathic>>>>>>genetic

Question 4

what does Parkinson’s often start with/first sign

Answer 4

UUNILATERAL resting tremor (don’t HAVE to start our with but often do 75%)

Question 5

when looking at brain, what is a hallmark to Parkinson’s

Answer 5

progressive Lewy Body accumulation starts in brainstem and then goes up to frontal cortex and then works it’s way back to occipital cortex (most found in brainstem)

Question 6

hypothesis as to why get tremor

Answer 6

some people are more sensitive to switch to loss of dopamine

Question 7

list four classical clinical features of Parkinson’s

Answer 7

Bradykinesia Muscular Rigidity Postural Instability Resting Tremor

Question 8

describe bradykinesia

Answer 8

slowness of executing movement “paucity” of movement

Question 9

describe muscular rigidity

Answer 9

increased tone velocity-independent cogwheel=rigidity+tremor

Question 10

describe postural instability

Answer 10

primary NOT due to visual, proprioceptive, vestibular, cerebellar deficits

Question 11

describe rest tremor

Answer 11

“pill-rolling” UNILATERAL/symmetric

Question 12

common appearance of gait in Parkinson’s

Answer 12

narrow stance, small-shuffling steps, stooped over

Question 13

what percent of Parkinson’s patients present with resting tremor initially and thought disease

Answer 13

75%

Question 14

non-motor features of Parkinson’s

Answer 14

see picture

Question 15

common non-motor features of Parkinson’s

Answer 15

fatigue, saliva, nocturia

Question 16

T/F everyone with Parkinsonism has Parkinson’s

Answer 16

False

Question 17

Possible causes of Parkinsonism or differential dx to Parkinson’s

Answer 17

stroke in areas of the brain that are affected in Parkinson’s (substantia nigra, cerebellum, striatum, caudate putamen) reaction to drugs (block dopamine) (i.e. antipsychotics)

Question 18

how to tell if Parkinsonism due to Parkinson’s or stroke

Answer 18

onset stroke get all of a sudden Parkinson’s is gradual onset

Question 19

how to tell if Parkinsonism due to Parkinson’s or drugs

Answer 19

are features presenting symmetrically or asymmetrically symmetrically due to drugs asymmetrically due to Parkinson’s

Question 20

why do you want to get definitive dx of Parkinson’s when looking at neurodegenerative disorders when treatment basically the same for all of them

Answer 20

prognosis quality of life Parkinson’s could still live 30 years Other neurodegenerative disorders 8-10 years

Question 21

T/F diagnosis of Parkinson’s is clinical

Answer 21

true

Question 22

T/F diagnosis of Parkinson’s is from good hx and physical

Answer 22

true

Question 23

define Parkinsonism

Answer 23

bradykinesia in combination with at least 1 of rest tremor or rigidity

Question 24

are reflexes impaired in those with Parkinson’s

Answer 24

no

Question 25

diagnostic criteria of Parkinson’s

Answer 25

see picture

Question 26

Parkinson’s diagnostic pearls

Answer 26

see picture

Question 27

what best slows down the progression of Parkinson’s

Answer 27

exercise

Question 28

goals of management of Parkinson’s

Answer 28

optimal quality of life patient-specific

Question 29

T/F medication adjustment over time is the norm when treating Parkinson’s

Answer 29

true

Question 30

Management strategies of Parkinson’s

Answer 30

see picture

Question 31

Parkinson’s medications

Answer 31

see picture

Question 32

rule when starting medications in Parkinson’s

Answer 32

start low and go slow

Question 33

common side effects of selected dopaminergics

Answer 33

see picture

Question 34

potential side effects of dopamine agonists like pramipexole (mirapex)

Answer 34

impulse controle disorders so impulsive shopping, gambling, hypersexuality, or binge eating

Question 35

define Parkinson’s

Answer 35

neurodegenerative disorder associated with loss of dopaminergic neurons in brainstem and accumulation of Lewy bodies throughout brain

Question 36

mainstay of pharmacotherapy for Parkinson’s motor symptoms

Answer 36

dopaminergic medications

Question 37

mechanism of Parkinson’s

Answer 37

dopamine neurons die so less dopamine less dopamine (inhibitory) means failure to inhibit Ach (excitatory) in basal ganglia thus increase GABA release (inhibitory)

Question 38

where is loss of pigment cells seen in Parkinson’s

Answer 38

substantia nigra which projects to the striatum

Question 39

age of onset of symptoms in Parkinson’s

Answer 39

45-65 years

Question 40

facial involvement in Parkinson’s

Answer 40

relatively immobile face/fixed facial expressions kinda giving you the death stare

Question 41

drug treatment of Parkinson’s

Answer 41

see picture (from pance prep pearls)