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Older Adult Exam 2 > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What is Parkinson’s disease?

A

Chronic, progressive, neurodegenerative disorder

- Characterized  by motor and non-motor symptoms
- Caused by depletion of dopamine producing neurons in 		the substantia nigra of the basal ganglia
- Presence of Lewy bodies (alpha-synuclein aggregates) in   		residual dopaminergic cells
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2
Q

Mutations in what gene have found to be the greatest genetic contributor to Parkinson’s?

A

LRRK2

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3
Q

Parkinson’s caused by genetic risk factors or environmental factors?

A

combo

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4
Q

High risk of developing PD: men or women?

A

men

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5
Q

How is PD diagnosed?

A

PD is a clinical diagnosis
Careful history with chronology of symptoms
Thorough physical exam
Positive levodopa response reinforces a PD diagnosis
DAT-SPECT?

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6
Q

What is seen on physical exam of someone with PD?

A

General Survey:

  • Skin changes (seborrheic dermatitis)
  • Orthostatic hypotension
  • Musculoskeletal changes due to aging or injury

Neuro Exam:

  • Mental status: Depression, anxiety, cognitive changes
  • Cranial nerves: Olfaction, limited upgaze, masked facies, hypophonia
  • Motor: cogwheel rigidity
  • Reflexes: + Myerson’s sign
  • Sensory: objectively normal; often subjective symptomatology
  • Coordination: decreased RAM speed
  • Gait: decreased arm swing, stooped posture, short or shuffling steps
  • MS: tremor
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7
Q

d/dx of PD

A 
Parkinson-plus syndromes including 
	- Progressive supranuclear palsy
	- Multiple system atrophy
	- Lewy body disease
Vascular parkinsonism
Drug-induced parkinsonism
Multifactorial gait disturbance
Essential tremor
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8
Q

Other diagnoses besides PD should be considered if:

A
  • No benefit from levodopa
    • Initial bilateral symptoms
    • Gait-predominant symptoms only
    • History of CVA, diabetes, psychiatric comorbidities, use of illegal drugs or antipsychotics
    • Abnormal eye movements upon exam
    • Early autonomic symptoms (think MSA)
    • Dementia or psychosis within one year of diagnosis (think lewy body dementia)
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9
Q

What are the cardinal motor symptoms of PD?

A

Tremor
Bradykinesia
Rigidity
(Postural instability)

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10
Q

Is the PD trimmer a rest tremor or an essential, or movement, tremor?

A

Rest tremor

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11
Q

What is more troubling for PD patient: motor symptoms or nonmotor symptoms?

A

Nonmotor symptoms are often reported as more disabling than motor symptoms

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12
Q

What drug extend the life of sinemet?

A

entacapone (Comtan)

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13
Q

What are the dopamine agonists and when should they be used in PD?

A
  • Requip (ropinirole)
  • Mirapex (pramipexole)
  • Rotigitine patch

Often used as first-line agent and early PD

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14
Q

What is rasagiline used for?

A

reduce off times

MAOB inhibitor, blocks breakdown of dopamine

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15
Q

Which medication is this a rescue medication in PD?

A

Apomorphine - injection

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16
Q

Which drug is used for tremor and dyskinesias in PD?

A

Amantadine
Antiviral
Caution, can cause confusion in elderly

17
Q

What is an alternative to amantadine when worried about causing confusion?

A

Rimantidine - causes less confusion

18
Q

What are common side effects of dopaminergic therapy?

A 
Nausea/GI side effects
Excessive daytime fatigue
Visual hallucinations and illusions
Dyskinesias
Orthostatic hypotension
Pitting edema
Impulse control disorders (ICD’s)
19
Q

What choices do you have for an initial medication management for those with PD?

A

Sinemet - most common choice
Rasagiline - for those early on who aren’t ready for TID meds
Dopamine agonist, such as Mirapex or Requip

20
Q

What causes psychosis in PD?

A

High dopamine levels or dementia

21
Q

What drugs are safe for tx psychosis in PD?

A

Seroquel
Clozaril
Pimavanserin
Do not use typical antipsychotics or neuroleptics

22
Q

What areas of the brain are targeted in deep brain stimulation?

A

Subthalamic nucleus

Globus pallidus interna

23
Q

What are some benefits of a deep brain stimulation?

A
  • Helps with tremor, bradykinesia, gait disturbance, dyskinesias, motor fluctuations
  • Reversible
  • Adjustable
  • Rechargeable
24
Q

What are some disadvantages of a deep brain stimulation?

A 
Implanted foreign body - risk of infections
Equipment failures
Battery replacement- rechargeable
Cost of equipment
Possible electromagnetic interference- 
Time and effort needed for programming
Side effects
25
Q

What are some late stage complications of PD?

A 
Dementia
Recurrent pneumonia
Dysphagia 
Communication barriers
Weight loss
Urinary incontinence
Infections
Pain
Caregiver burden

Older Adult Exam 2 (8 decks)

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