Parkinson's Flashcards
What is the pathology in PD?
Loss of dark pigment in substantial nigra (in basal ganglia)
Which type of cell loss causes the pigment loss?
Dopaminergic
What is the histological finding in PD?
Lewy bodies
What are the motor features in PD?
Tremor
Bradykinesia
Rigidity
Postural instability
What are the non motor features in PD?
Sleep disorders Hallucinations GI dysfunction Depression Dementia (late disease) Anosmia
What are the essential criteria for diagnosis of PD?
Bradykinesia + one or more of:
- resting tremor (pill-rolling)
- rigidity (cogwheel or lead pipe)
- postural instability
Is onset of PD unilateral or bilateral?
Unilateral
What might be observed in a parkinsonian gait?
Stooped, fixed posture
Reduced arm swing
Shuffling, short stepped gait
Slow turning
What might be observed in the face of someone with PD?
Hypomimia (reduced expression –> masked face)
How is PD diagnosed?
Clinically
structural imaging and SPECT may be helpful
Which factors are thought to increase the risk of developing PD?
Pesticides Head injury Rural living Beta-Blockers Agricultural occupation Well water drinking
Which factors are thought to decrease the risk of developing PD?
Tobacco smoking Coffee NSAID use Calcium channel blockers Alcohol consumption
Name 2 genes linked to PD
LRRK2
PARKIN
What is the role of treatment in PD?
Symptomatic treatment by increasing intracerebral dopamine or stimulating dopamine receptors
No neuroprotective of disease modifying drugs for PD
When should treatment with levodopa be initiated?
When symptoms cause disability
What is the problem with one term levodopa use?
Motor complications including:
- dyskinesias (involuntary movements)
- painful dystonias
- fluctuations in response –> “off freezing”
How does levodopa work?
It is converted to dopamine in the brain
What are the non motor side effects of levodopa?
Nausea and vomiting
Tolerance (increased dose required to elicit same effect)
Psychosis
Visual hallucinations
Which type of drug can be given to delay starting levodopa in early disease? Give two examples
Dopamine agonists
- ropinirole
- pramipexole
What are the side effects of dopamine agonists?
Nausea Daytime sleepiness Oedema Gambling and hyper sexuality Hallucinations
Which patients should not be given dopamine agonists?
Patients with history of addiction/OCD
Elderly (hallucinations)
Which other class of drugs can be used in PD? Give 2 examples
Monoamine oxidase (MAO-B) inhibitors
- rasagiline
- selegiline
Which drug can be given for drooling of saliva in PD?
Glycopyrronium bromide
Which drug should be given for orthostatic hypotension in PD?
Midodrine
