Parkinson's disease

Question 1

What is the triad of parkinson’s disease?

Answer 1

bradykinesia, tremor, rigidity (+gait)

Question 2

How to accentuate tremor?

Answer 2

close eyes and count backwards from 20= activation maneuver. Essentially distract the patient

Question 3

What can you ask the patient to do to emphasize bradykinesia?

Answer 3

finger tapping, toe tapping (decreased in amplitude and slower with progression)

Question 4

Will there be bilateral tremors of equal severity in PD?

Answer 4

usually asymmetrical, one side is worse than the other

Question 5

In what two ways can increased tone be described?

Answer 5

spasticity and rigidity

Question 6

Clasp knife is a sign of which disease?

Answer 6

UMN disease, passive flexion of elbow is met with resistance

Question 7

What are the facial features of PD?

Answer 7

mask like face/minimal expressions= hypomimia, minimal blinking

Question 8

What are the non-motor features of PD?

Answer 8

sleep dysfunction, depression, quiet voice, loss of sense of smell, micrographia (small handwriting), constipation, postural hypotension, urinary frequency

Question 9

A PD patient is NBM but they require their medications. What should you do?

Answer 9

NG tube or drugs in patch formulation

Question 10

What are the differentials for PD?

Answer 10

1. Drug induced
2. Lewy body dementia
3. Multi systems atrophy
4. Supra bulbar
5. Infection- syphilis, HIV
6. Genetic- Wilson’s disease

Question 11

Which drugs can induce parkinsonism?

Answer 11

antipsychotics and CCBs

Question 12

List three parkinson’s plus syndromes

Answer 12

1. multiple systems atrophy
2. progressive supranuclear palsy
3. corticobasilar degeneration
4. lewy body dementia

Question 13

Where does destruction of dopaminergic neurons arise in PD?

Answer 13

pars compacta of substantia nigra

Question 14

Which abnormal proteins arise in PD?

Answer 14

beta amyloid plaques and neurofibrillary tangles: hyperphosphorylated tau

Question 15

List three side effects of L-DOPA

Answer 15

DOPAMINE
Dyskinesia
On-off phenomena
Psychosis
ABP decrease
Mouth dryness
Insomnia
N/V
EDS excessive daytime sleepiness

Question 16

Which imaging is used to diagnose PD?

Answer 16

DaTSCAN

Question 17

Differentials for PD?

Answer 17

  Parkinson plus syndromes 
  Multiple infarcts 
  Drugs: neuroleptics 
  Inherited: Wilson’s 
  Infection: HIV, syphilis, CJD 
  Dementia pugilistica

Question 18

What are red flag symptoms of PD?

Answer 18

wheelchair use within 5y, resp dysfunction, autonomic failure, early falls within 3y diagnosis

Question 19

Name the drug classes used for PD?

Answer 19

L-dopa, dopamine agonists, MAO-B inhibitors, COMT inhibitors

Question 20

Which adjunct is commonly formulated with L dopa?

Answer 20

peripheral DOPA decarboxylase inhibitors: carbidopa and BENSERAZIDE

Question 21

What are the PERIPHERAL adverse effects of L dopa preparations?

Answer 21

nausea, vomiting, postural hypotension

Question 22

Name two side effects of dopamine agonists?

Answer 22

impulse control disorders e.g. gambling, daytime somnolescence/sleepiness

Question 23

Name one example of MAO-B inhibitors

Answer 23

selegiline and rasagiline

Question 24

Name a COMT inhibitor

Answer 24

entacapone, opicapone

Question 25

Aside from treating motor symptoms, what should be taken into account when considering PD patient?

Answer 25

bone health, exercise, support groups, advanced care planning

Question 26

What are the treatment options in advanced PD?

Answer 26

apomorphine pen injections, intrajejunal duodopa infusion, deep brain stimulation

Question 27

Are COMT inhibitors effective on their own?

Answer 27

require L Dopa as they extend the half life/duration of action

Question 28

Name examples of dopamine agonists

Answer 28

ropinirole, pramipexole, rotigotine, apomorphine