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Neurology > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What causes PD?

A

Degeneration of the dopamine-producing neurons found within the substantia nigra.

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2
Q

Name 2 genes associated with PD?

A

Parkin

Alpha-synuclein

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3
Q

Which part of the brain are the substantia nigra found in?

A

There are 2 of these, found either side of the midbrain.

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4
Q

What are the characteristic symptoms of PD?

A

Tremor (resting)
Rigidity
Akinesia
Postural instability

Remember TRAP!

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5
Q

What is the difference in the tremor experienced in cerebellar dysfunction compared with that of PD?

A

Tremor in PD is at rest, improves with movement.

Tremor in cerebellar dysfunction is an intention tremor (not present at rest).

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6
Q

What is meant by rigidity?

A

Increased muscle tone felt when trying to move limbs passively.

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7
Q

What test is used to check for rigidity?

A

Froment’s manoeuvre.

This initiates the ‘cogwheel’ sign.

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8
Q

What is akinesia?

A

Slowness/absence of voluntary muscle movement.

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9
Q

What is the typical gait observed in a PD patient?

A

Slow gait, with narrow, shuffling steps.

Hesitation initiating movement and a stooped posture.

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10
Q

Which test is used to analyse posture and gait in suspected PD?

A

Pull test.

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11
Q

Are most cases of PD idiopathic or genetic?

A

Idiopathic (95%).

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12
Q

What is thought to be a marker of neuronal ill-health?

A

Presence of Lewy bodies.

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13
Q

Is PD the most common neurodegenerative disease?

A

No, Alzheimer’s disease is - PD is second.

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14
Q

What investigation methods are used in the diagnosis of PD?

A

It is usually a clinical diagnosis, although a DaTSCAN can be helpful (this shows function, not structure).

Response to dopamine therapy will back-up diagnosis.

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15
Q

What is a major prevailing factor common in those with PD?

A

Old age.

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16
Q

What non-motor symptoms are linked to PD?

A 
Late-onset hyposmia
Depression/anxiety
Constipation
Bladder issues
Pain
Mild cognitive impairment
17
Q

What are the 4 main types of drug used in PD?

A

Levodopa
COMT inhibitors
MAO-B inhibitors
Dopamine agonists

18
Q

Which therapy is first-line in PD management?

A

Levodopa.

19
Q

Why is levodopa an inactive form of dopamine?

A

To allow it to cross the blood-brain-barrier.

20
Q

What is given alongside levodopa to produce active dopamine?

A

Carbidopa.

21
Q

In those with levodopa-induced nausea and vomiting, what is given?

A

Domperidone.

22
Q

What is the role of COMT inhibitors?

A

Blocks the enzymatic breakdown of levodopa prior to it crossing the blood brain barrier.

23
Q

In PD, dopamine levels are decreased. What other neurotransmitter must be controlled in these patients to stop symptoms?

A

Acetylcholine.

24
Q

What drugs are given to prevent tremor?

A

Anticholinergics.

Remember cause dryness.

25
Q

Are treatment methods in PD preventative or do they aim to manage symptoms?

A

Symptomatic relief only - disease progression inevitable.

26
Q

What are side-effects of dopamine agonists?

A

Impulsive behaviour
Sleepiness
Psychosis

27
Q

What drugs can cause drug-induced PD?

A

Chlorpromazine
Metoclopramide
Methyldopa
Diltiazem

28
Q

What are some long-term complications of dopamine therapy?

A

Motor fluctuations
Non-motor fluctuations
Dyskinesia
Drug-induced psychosis

29
Q

When are MAO inhibitors used?

A

In moderate disease only.

30
Q

How does substantia nigra degeneration present?

A

Loss of characteristic black appearance of the regions.

31
Q

Is muscle weakness a feature of PD?

A

No.

This helps to set it apart from issues with the motor cortex and the corticospinal pathway.

32
Q

Tremor is most commonly seen in which part of the body?

A

Upper limbs.

33
Q

Is PD a condition characterised by symmetrical disease?

A

No, patients will have asymmetrical symptoms.

34
Q

What % of PD patients develop Parkinson’s dementia?

A

Around 80%.

35
Q

What is the difference between dementia with lewy bodies and Parkinson’s dementia?

A

Parkinson’s dementia will present after a year of PD - DwLB presents earlier.

36
Q

Can PD be drug-induced?

A

Yes, following a few months of treatment withdrawal, symptoms will improve.

37
Q

Which test is used to induce postural instability in an individual suspected to have PD?

A

The pull test.

38
Q

Is PD usually symmetrical at point of onset?

A

No, it is common for PD to begin asymmetrically.

Neurology (22 decks)

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