Parkinson's Flashcards
What is Parkinson’s? (3)
- A progressive, incurable neurological disorder
- Associated with loss of dopamine-generating cells in the brain
- Loss of motor control and other motor symptoms
What is the cause of Parkinson’s? (2)
- Loss of nerve cells in the substantia nigra
2. Leads to reduction of dopamine in the brain
What is the role of dopamine?
- Regulates bodily movements and reduction is responsible for many of the symptoms
What causes the death of cells in Parkinson’s?
- Cause of death is unclear, thought to be complex genetic and environmental factor combination
- Around 15% have first-degree relative with PD
- 5-10% have forms that can occur due to mutations in specific genes
What pathways are affected in PD? (5)
- Motor
- Oculomotor
- Associative
- Limbic
- Orbitofrontal
What are the 3 main symptoms of PD?
Tremor, bradykinesia and rigidity
What is bradykinesia?
Slow movement
Give 8 other motor symptoms of PD
- Freezing - stuck in place when attempting to walk
- Low voice volume of muffled speech
- Lack of facial expression
- Stiffness or rigidity of the arms, legs or trunk
- Balance problems and falls
- Stooped posture
- Dysphagia and drooling
- Festination (short, running steps)
Give 14 non-motor symptoms of PD
- Depression
- Anxiety
- Constipation
- Cognitive decline and demtnia
- Impulse control disorders
- Pain
- Hallucinations and psychosis
- Sexual dysfunction
- Sleep disturbances
- Urinary dysfunction
- Anosmia (sense of smell)
- Nerve plain - unpleasant sensations, burning, coldness, numbness
- Dizziness, blurred vision, fainting
- Hyperhidrosis
What are Parkinson’s-plus syndrome?
- Group of disorders characterised by the degeneration of nerve cells in different parts of the brain
- Have parkinsonian features as well as others not associated with Parkinson’s
- Usually respond poorly to levodopa or dopamine agonists
Give 3 examples of Parkinson’s-plus syndromes
- Supranuclear palsy (SP)
- Corticobasal degeneration (CBD)
- Multiple system atrophy (MSA)
What is secondary or symptomatic Parkinsonism?
- Describes syndrome of parkinsonism when it occurs as the result of an indentifiable cause
Eg. medication (antipsychotic drugs), brain tumour, strokes, infections (eg. encephalitis) and toxins (carbon monoxide, manganese)
What are the 3 stages of Parkinson’s?
- Early
- Moderate
- Advantaced
What is the early stage of Parkinson’s? (2)
- Mild tremor or stiffness but able to continue work/daily activites
- Newly diagnosed
What is the moderate stage of Parkinson’s? (2)
- Begins to experience limited movement
2. Mild-moderate tremor with slow movement
What is the advanced stage of Parkinson’s? (3)
- Significantly limited in activity, despite treatment
- Daily changes in symptoms, medication side effects that limit treatment and loss of independence
- Significant problems with posture, movement and speech
What is stage I of PD?
Symptoms affect one side of body only
What is stage II of PD?
Both sides of body affected but posture remains normal
What is stage III of PD?
Both sides of body affected
Mild imbalance whilst standing or walking
Person remains independent
What is stage IV of PD?
Both sides of body affected
Disability instability whilst walking or standing
Requires substantial help
What is stage V of PD?
Severe, fully develop disease is present
How is PD diagnosed? (7)
- Based on symptoms, medical history and physical examination (no tests can conclusively show PD)
- Perform mental or physical tasks eg. moving, walking
- Referred to specialist
- Have 2/3 of the main symptoms (tremor, bradykinesia, rigidity)
- SPECT (single positron emission computed tomography) to rule out other causes of symptoms
- If symptoms improve after levodopa - likely to have PD
- Findings of Lewy bodies in brain in autopsy
What specialists is a person with suspected PD likely to be referred to?
- Neurologist
2. Geriatrician (problems affecting elderly people)
What is the course of PD?
- Symptoms can change day to day and even from hour to hour, unique in each person
What is the prognosis of PD? (3)
- Life expectancy won’t change much for most people
- Some of the more advanced symptoms = increased disability and poor health, making more vulnerable to infection eg. dysphagia leading to aspiration, loss of balance causing serious falls
- Neurologists report that symptom deterioration is significantly slower in those who take a positive and proactive approach towards their condition
Summarise the interventions for PD (5)
- Currently no cure but treatments reduce symptoms and maintain QoL
- Supportive treatments: Physio, OT, SLT, dietitian
- Medication
- Surgery
- Treating additional symptoms
What are the 3 main types of medication used in PD?
- Levodopa
- Dopamine agonists
- Monoamine oxidase-B inhibitors
What is the function of levodopa?
- Absorbed by nerve cells and converted to dopamine to transmit messages between brain and nerves
- Improves movement problems
What are the side effects of levodopa? (3)
Nausea/vomiting
Tired
Dizziness
What are the long-term effects of using levodopa? (3)
- Doses may need to be increased over time as more nerve cells are lost
- Uncontrollable, jerky movements
- “On-off” effects - switches between being able to move and being immobile
What is the function of dopamine agonists?
- Acts as a substitute for dopamine
2. Milder but similar effect to levodopa
What are the side effects of dopamine agonists? (5)
- Nausea/vomiting
- Dizziness
- Fatigue
- Hallucinations and increased confusion
- Has been linked to compulsive behaviours
What is the function of monoamine oxidase-B inhibitors?
- Block the effect of an enzyme that breaks down dopamine
2. Not as effective as levodopa but can improve symptoms
What are the side effects of monoamine oxidase-B inhibitiors?
- Nausea
- Headaches
- Abdominal pain
- High blood pressure
What is the function of cathecol-O-methyltransferase inhibitors?
- Prevent levodopa being broken down by the enzyme COMT
2. Used in later stages
What are 2 types of surgery used for Parkinson’s?
- Deep brain stimulation
2. Lesioning (rare)
What is deep brain stimulation? (3)
- Surgically implanting a pulse generator in chest wall
- Connected to fine wires placed under the skin and inserted into specific brain areas
- Generates electric current which stimulates affected brain areas
What are 6 benefits of deep brain stimulation?
- Can ease symptoms
- Helps control movement symptoms for a longer period over medication alone
- Increased number of “on” hours
- Medication can be reduced - reducing side effects
- Relieve non-motor ability
- Improve ability to perform daily activities
What is lesioning? (2)
- Making selective damage to cells in the brain using a brain scan to select some cells that control movement
- Now rarely used
What are the common sites for lesioning? (3)
- Thalamus (thalamotomy)
- Globus pallidus (pallidotomy)
- Subthalamic nucleus (subthalamotomy)
