Parkinson's Flashcards
How do movement disorders present?
Bradykinesia Muscle rigidity Resting tremor Postural instability with no other cause Anosmia (loss of sense of smell) Depression Constipation Mask-like face Quiet dysarthric voice (slurred or slow speech that can be difficult to understand) Micrographia (abnormally small, cramped handwriting or the progression is continually smaller handwriting) Gait problems/falls Dementia (advanced disease)
What is the diagnostic criteria for Parkinson’s?
Bradykinesia (upper body) AND Muscle rigidity Or Resting tremor (4-6Hz) OR Postural instability with no other cause
What are the supportive feature for a diagnosis of Parkinson’s?
Unilateral onset Rest tremor present Progressive Persistent asymmetry affecting side of onset most Excellent response to levodopa Severe levodopa-induced chorea Levodopa response for 5 years or more Clinical course of ten years or more
What is SPECT scanning?
DAT (dopamine active transporter) is located on the pre-synaptic terminals on dopaminergic neurones
[123I] beta-CIT is a radiolabelled cocaine derivative that binds to DAT
degeneration of nigrostriatal neurones will be associated with reduced ligand binding
What is seen on a normal SPECT scan?
Essential tremor
Drug induced EPS
Somatisation
What is seen on an abnormal SPECT scan?
Idiopathic PD
Multiple system atrophy PSP
Lewy body Dementia
What are the environmental risk factors for Parkinson’s disease?
Toxins:
MPTP, pesticides rural living, drinking well water, manganese
Infections- post encephalitic Parkinsonism
Head injury
Protective factors- cigarette smoking and caffeine
What is the prevalence of Parkinson’s?
0.3% of over 40s suffer with Parkinson’s 2% of over 80s suffer with Parkinson’s 120,000 sufferers in the UK- 1 in 500 people 1 in 20 are diagnosed under 40 y/o 1.35 men: 1 women
What is the non-pharmacolgical management
Comprehensive Geriatric Assessment Social support & care Driving Education & advice (1:1/group) OT- equipment, environment Physio- especially once falling Non-motor symptom control Constipation Sleep Autonomic dysfunction Mood Dementia- rivastigmine
What is essential tremor?
Prevalence 5%
50% have family history
Postural not resting
Affects arms/head not legs
Better after alcohol-often leads to self-medication
Will not progress to other symptoms eg. no dementia and normal life expectancy
Slight response to treatment- beta blockers
What is vascular Parkinsonism?
Due to small vessel ischaemia
Associated with artherosclerotic risk factors
Causes falls, voice changes and early cogntitive deficits
Legs are more affected than arms- bilateral
Stepwise rapid progression
Poor response to levo-dopaso control risk factors
What is drug induced Parkinsonism?
Parkinson’s due to lack of dopamine- therefore, dopamine antagonists can induce parkinsonism eg. anti- psychotics & anti-emetics
Most resolve when drugs stopped, however, patient may still require anti-psychotics (quetiapine is lower risk)
What are the additional features of Parkinson’s?
- Micrographia – small writing. Detected by getting the patient to write their name
- Abnormal gait – slow to initiate, shuffling, short steps, gets faster as momentum is gained (festination), freezing
- Expressionless face (hypomimia/masking)
- Pressure sores
- Aspiration pneumonia
- Recurrent falls
- Constipation
- Incontinent of urine
- Not able to talk properly (=dysarthria)
- Salivation (=dysphagia)
- Orthostatic hypertension
- Not the same personality (cognitive changes)
What is levy body dementia?
Dementia before Parkinsonism
Prominent cognitive impairment presenting at same time as Parkinsonism or within a few months
Prominent hallucinations
Fluctuations in level of consciousness
What is progressive supra nuclear palsy?
Eye signs- vertical gaze palsy
Cognitive impairment with frontal disinhibition
Not responsive Tod dopaminergic treatment
