Parkinson's and gait lecture

Question 1

Is Parkinson’s typically a sudden onset or a slow progressing condition?

Answer 1

slow progressing

Also typically asymmetrical at first, eventually both sides

Question 2

What signs show bradykinesia/akinesia?

Answer 2

Problems doing up buttons, typing on a keyboard
Writing smaller
Walking deteriorated, small steps, dragging one foot

Question 3

What are symptoms apparent when walking in Parkinson’s?

Answer 3

Small, stepped gait
Stooped posture
Reduced arm swing on one side
Stiffness

Question 4

What are the different types of tremor?

Answer 4

Rest tremor
Action tremor
Intention tremor

Question 5

Pathophysiology of Parkinson’s:
Cell loss of d_____ neurons in the substantia nigra
Also has l___ bodies present

Answer 5

dopamine

Lewy

Question 6

What causes Parkinson’s?

Answer 6

Inherited factors with environmental factors
Single gene defect (rare)

Question 7

What drugs are available for Parkinson’s?

Answer 7

MAO-B inhibitors (eg. rasagiline, not v powerful helps some patients)

DA agonists (first line in under 60 y/o, can give some behavioural side effects)

L-DOPA

Question 8

What autonomic problems can Parkinson’s have?

Answer 8

Constipation
Increased urinary frequency
Urinary incontinence

Question 9

What psychiatric conditions can Parkinson’s cause?

Answer 9

Depression
Anxiety disorder
Phobias
Hallucinations
Dementia

Question 10

What are differential diagnoses of Parkinson’s?

Answer 10

If tremor is:
on action rather than rest,
improves after alcohol,
family history

Think essential tremor.

Question 11

What treatment is available for essential tremor?

Answer 11

Primidone
Beta-blockers (contraindicated for asthma and diabetes)
Others like gabapentin, clonazepam