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MD2 Medicine > Parkinson's and Movement Disorders > Flashcards

Parkinson's and Movement Disorders Flashcards

1
Q

What is the most common movement disorder?

A

Parkinson’s disease

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2
Q

What is the age distribution of Parkinson’s disease?

A

Incidence rapidly increases over 60

Mean age of diagnosis = 70

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3
Q

What are the cardinal features of Parkinson’s disease?

A

Tremor
Bradykinesia
Rigidity
Postural instability

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4
Q

What is dyskinesia?

A 
Reversible levodopa-induced motor complication
Abnormal involuntary movements
- Choreic
- Dystonic
- Ballistic
- Myotonic
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5
Q

How is dyskinesia treated?

A

Adjusting levodopa dose

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6
Q

What is dystonia?

A

Involuntary muscle contraction involving abnormal movements and postures
More sustained abnormal posture than dyskinesia
Can be
- Under-treated Parkinson’s disease motor symptom
- Complication of levodopa treatment

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7
Q

What is the mechanism of action of levodopa?

A

Replacement of dopamine via prodrug

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8
Q

On which symptoms of Parkinson’s disease is levodopa most effective?

A

Hypokinetic motor symptoms
Also works on
- Tremor
- Rigidity

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9
Q

With which other drug is levodopa always combined, and why?

A

Combined with peripheral decarboxylase inhibitor to minimise peripheral conversion to dopamine

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10
Q

What are the gastrointestinal adverse effects of levodopa?

A

Nausea

Abdominal cramping diarrhoea

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11
Q

What are the neurological adverse effects of levodopa?

A

Somnolence
Dizziness
Headache

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12
Q

What are the psychiatric adverse effects of levodopa?

A 
Confusion
Hallucinations
Delusions
Agitation
Psychosis
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13
Q

What are the cardiovascular adverse effects of levodopa?

A

Orthostatic hypotension

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14
Q

What are motor fluctuation, in terms of levodopa-related complications?

A

Wearing-off = end-of-dose effect
On-off syndrome = episodes of unpredictable “off” alternating with “on” +/- dyskinesia
Failure to turn “on” = due to excessively prolonged/severe “off” period
Acute akinesia = akinetic state last for days and not responding to antiparkinson medications = sudden exacerbation

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15
Q

What are other medications used in Parkinson’s disease?

A 
COMT inhibitors
MAO inhibitors
Dopamine agonists
Anticholinergics
Amantadine
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16
Q

What are non-motor features of Parkinson’s disease?

A

Orthostatic hypotension
Urine frequency
Constipation

17
Q

What are the psychological aspects of Parkinson’s disease?

A

Depression
Anxiety
Apathy and abulia
Sleep disturbance

18
Q

What are the differential diagnoses of a tremor?

A 
Parkinsonian
Essential
Enhanced physiological
Drug induced
Cerebellar
Dystonia
19
Q

What are the characteristics of an essential tremor?

A 
Gradual onset
Bilateral
Resting tremor worse than kinetic
Ethanol improves tremor
FHx
20
Q

What are the characteristics of a Parkinsonian tremor?

A

Asymmetrical
Onset latency = tremor starts later than posture
Pronation-supination tremor
Coarse tremor

21
Q

What sort of balance is affected in Parkinson’s disease?

A

Medio-lateral balance more than antero-posterior

22
Q

Why is an MRI done in Parkinson’s disease if it is a clinical diagnosis?

A

To look for structural problems

  • Normal pressure hydrocephalus
  • Subdural haematoma
  • Stroke in basal ganglia
23
Q

What things does bradykinesia cause in Parkinson’s disease?

A 
Hypo-expressions
Slower blinking >  dry eyes
Eating slower
Drooling
Gastroparesis > full early on
Constipation
24
Q

What is akinetic rigid syndrome in Parkinson’s disease?

A

Don’t have tremor, but

  • Stiff
  • Rigid
  • More falls
25
Q

What proportion of Parkinson’s patients have akinetic rigid syndrome, and what proportion are tremor dominant?

A

Akinetic rigid syndrome = 30%

Tremor dominant = 70%

26
Q

What is the prognosis for patients with akinetic rigid syndrome, compared with those who are tremor dominant?

A

Faster progression
Worse response to medication
Poorer outcome

27
Q

What is the abnormal protein in Parkinson’s disease?

A

Alpha synuclein

28
Q

Which part of the brain is disproportionately affected in Parkinson’s disease?

A

Substantia nigra

29
Q

What are the pre-motor features of Parkinson’s disease?

A 
Anosmia
Mood disturbance - apathy
Impulsive behaviours
Sleep disturbance
- Insomnia
- Nightmares
- Myoclonic jerks
- Cramps
- Rigidity
- Vivid dreams
- REM behaviour disorder
30
Q

What happens when Parkinson’s disease progresses to the cortex?

A

Parkinson’s disease dementia

31
Q

How can bradykinesia be tested on examination?

A 
Tapping fingers
Opening and closing hands
Toe tapping
Heel tapping
Have to make movements big and quick to demonstrate frequency and amplitude
32
Q

Compare rigidity and spasticity

A 
Rigidity = extrapyramidal
Spasticity = pyramidal
33
Q

Compare lead pipe rigidity to clasped knife rigidity

A

Lead pipe = resistance stays the same

Clasped knife = resistance decreases

34
Q

What produces cogwheeling in Parkinson’s disease?

A

Tremor superimposed over rigidity

35
Q

How is postural instability tested for on examination?

A

Retropulsion test > will fall like leaf/take >6 steps

36
Q

What are the features of gait in Parkinson’s disease?

A 
Difficulty standing up
Slight flexion of knee, anterior flexion of trunk, anterior flexion of neck
Gait initiation problem = difficulty taking 1st step
Shortened stride length
Reduced step height
Reduced arm swing
Narrow-based gait
Festination
Reappearance of tremor
37
Q

How is mediolateral balance tested on examination?

A

Heel-to-toe walking

Stand on 1 leg while other leg’s knee held above waist height

38
Q

What drugs can cause a drug-induced tremor?

A 
Thyroxine
Caffeine
Anti-psychotics, especially typical
Dopamine blocking agents; eg: metoclopramide
Beta agonists; eg: salbutamol

MD2 Medicine (18 decks)

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