Parkinson's Flashcards
number one risk factor for Parkinson’s
aging 2-4% risk >60 years
do males or females get Parkinson’s more
Males 3:2 (M:F)
etiology of Parkinson’s
idiopathic>>>>>>genetic
what does Parkinson’s often start with/first sign
UUNILATERAL resting tremor (don’t HAVE to start our with but often do 75%)
when looking at brain, what is a hallmark to Parkinson’s
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)
hypothesis as to why get tremor
some people are more sensitive to switch to loss of dopamine
list four classical clinical features of Parkinson’s
Bradykinesia Muscular Rigidity Postural Instability Resting Tremor
describe bradykinesia
slowness of executing movement “paucity” of movement
describe muscular rigidity
increased tone velocity-independent cogwheel=rigidity+tremor
describe postural instability
primary NOT due to visual, proprioceptive, vestibular, cerebellar deficits
describe rest tremor
“pill-rolling” UNILATERAL/symmetric
common appearance of gait in Parkinson’s
narrow stance, small-shuffling steps, stooped over
what percent of Parkinson’s patients present with resting tremor initially and thought disease
75%
non-motor features of Parkinson’s
see picture
common non-motor features of Parkinson’s
fatigue, saliva, nocturia
T/F everyone with Parkinsonism has Parkinson’s
False
Possible causes of Parkinsonism or differential dx to Parkinson’s
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)
how to tell if Parkinsonism due to Parkinson’s or stroke
onset stroke get all of a sudden Parkinson’s is gradual onset
how to tell if Parkinsonism due to Parkinson’s or drugs
are features presenting symmetrically or asymmetrically symmetrically due to drugs asymmetrically due to Parkinson’s
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
prognosis quality of life Parkinson’s could still live 30 years Other neurodegenerative disorders 8-10 years
T/F diagnosis of Parkinson’s is clinical
true
T/F diagnosis of Parkinson’s is from good hx and physical
true
define Parkinsonism
bradykinesia in combination with at least 1 of rest tremor or rigidity
are reflexes impaired in those with Parkinson’s
no
diagnostic criteria of Parkinson’s
see picture
Parkinson’s diagnostic pearls
see picture
what best slows down the progression of Parkinson’s
exercise
goals of management of Parkinson’s
optimal quality of life patient-specific
T/F medication adjustment over time is the norm when treating Parkinson’s
true
Management strategies of Parkinson’s
see picture
Parkinson’s medications
see picture
rule when starting medications in Parkinson’s
start low and go slow
common side effects of selected dopaminergics
see picture
potential side effects of dopamine agonists like pramipexole (mirapex)
impulse controle disorders so impulsive shopping, gambling, hypersexuality, or binge eating
define Parkinson’s
neurodegenerative disorder associated with loss of dopaminergic neurons in brainstem and accumulation of Lewy bodies throughout brain
mainstay of pharmacotherapy for Parkinson’s motor symptoms
dopaminergic medications
mechanism of Parkinson’s
dopamine neurons die so less dopamine less dopamine (inhibitory) means failure to inhibit Ach (excitatory) in basal ganglia thus increase GABA release (inhibitory)
where is loss of pigment cells seen in Parkinson’s
substantia nigra which projects to the striatum
age of onset of symptoms in Parkinson’s
45-65 years
facial involvement in Parkinson’s
relatively immobile face/fixed facial expressions kinda giving you the death stare
drug treatment of Parkinson’s
see picture (from pance prep pearls)
