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Year Two - Neurology System > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What is Parkinson’s disease?

A

It is defined as a progressive neurodegenerative condition caused by a reduction of dopaminergic neurons in the substantia nigra pars compacta of the basal ganglia

This results in a reduction in dopamine levels and therefore dysregulation of the basal ganglia

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2
Q

What is the basal ganglia? What are its three functions?

A

It is a group of structures situated in the middle of the brain

To coordinate habitual movements

To control voluntary movements

To learn specific movement patterns

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3
Q

What is the substantia nigra? What is its function?

A

It forms a component of the basal ganglia

It produces dopamine

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4
Q

What is dopamine? What is its function?

A

Neurotransmitter

It is essential for the correct functioning of the basal ganglia

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5
Q

What are the five risk factors associated with Parkinson’s disease?

A

Increasing Age > 65 Years Old

Male Gender

Family History

Dopamine Antagonist Drugs

Vascular Disease

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6
Q

What are the three genes associated with Parkinson’s disease?

A

LLRK

Parkin

Glucocerebrosidase (GBA)

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7
Q

Is the LLRK gene - autosomal dominant or autosomal recessive?

A

Autosomal dominant

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8
Q

When does the LLRK gene result in the onset of Parkinson’s disease?

A

Late onset

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9
Q

Is the Parkin gene - autosomal dominant or autosomal recessive?

A

Autosomal recessive

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10
Q

When does the Parkin gene result in the onset of Parkinson’s disease?

A

Early onset

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11
Q

Name three dopamine antagonist drugs that can cause Parkinson’s disease

A

Memantine

Metoclopramide

Antipsychotics

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12
Q

Which antipsychotic can cause Parkinson’s disease?

A

Haloperidol

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13
Q

What is a characteristic feature of Parkinson’s clinical features?

A

Asymmetrical

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14
Q

What are the triad of clinical features associated with Parkinson’s disease?

A

Bradykinesia

Tremor

Rigidity

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15
Q

What is another term for bradykinesia?

A

Hypokinesia

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16
Q

What is bradykinesia?

A

It describes slowness of movements, with a decrease in amplitude through repetition

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17
Q

What are the three features of Parkinson’s bradykinesia?

A

Micrographia

Shuffling Gait

Hypomimia

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18
Q

What is micrographia?

A

It is is defined as handwriting getting smaller and smaller

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19
Q

What are the three features of a shuffling gait?

A

It describes individuals taking small steps when walking, in which their foot doesn’t fully lift up from the ground

They will also have difficulty in turning around when standing

They will have reduced arm swinging

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20
Q

What is hypomimia?

A

It describes reduced facial movements and facial expressions

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21
Q

What tremor is Parkinson’s disease?

A

A unilateral ‘pill rolling tremor’

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22
Q

What is a pill rolling tremor?

A

A tremor in which individuals appear to be rolling a pill between their index finger and thumb

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23
Q

When does the Parkinson’s tremor become worse?

A

At rest

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24
Q

When does the Parkinson’s tremor improve?

A

When conducting voluntary movements

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25
Q

What is the frequency of Parkinson’s tremor? What does this mean?

A

3 -5 Hz

The tremor occurs between three to five times a second

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26
Q

What is rigidity?

A

It is defined as a resistance to passive movement of a joint, due to stiffness and tension in the muscles

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27
Q

What are the two types of rigidity associated with Parkinson’s?

A

Lead Pipe Rigidity

Cogwheel Rigidity

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28
Q

What is lead pipe rigidity?

A

It is defined as a constant resistance to motion throughout the entire range of movement

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29
Q

What is cogwheel rigidity?

A

It is defined as a resistance to movements that is intermittent through its range of motion, resulting in small jerky movements

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30
Q

What are the six additional clinical features associated with Parkinson’s?

A

Depression

REM Sleep Behaviour Disorder

Anosmia

Postural Instability

Autonomic Dysfunction

Cognitive Impairment

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31
Q

What is REM sleep behaviour disorder?

A

It is defined as a loss of atonia during the REM phase of sleep, causing motor enactment of dreams

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32
Q

What is atonia?

A

It is defined as a loss of muscle tone

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33
Q

What is anosmia?

A

It is defined as a loss of the sense of smell

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34
Q

What autonomic dysfunction feature is associated with Parkinson’s disease?

A

Postural hypotension

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35
Q

What dermatological condition is Parkinson’s disease associated with?

A

Seborrhoeic dermatitis

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36
Q

What cause of Parkinson’s disease presently differently?

A

Drug induced Parkinsonism

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37
Q

How does drug induced parkinsonism present?

A

The motor clinical features present rapidly and bilaterally

The features of rigidity and tremor are uncommon

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38
Q

What is the pharmacological management option for tremor in drug-induced parkinsonism?

A

Procyclidine

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39
Q

How do we diagnose Parkinson’s?

A

There are no specific investigations that can be conducted

Instead, diagnosis is clinically based using the ‘UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria’

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40
Q

In cases where patients present with suspected Parkinson’s disease, what is the most appropriate next step?

A

We refer to neurology

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41
Q

What investigation is used to diagnose Parkinson’s when the diagnosis is unclear?

A

123I-FP-CIT single photon emission computed tomography (SPECT) scan

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42
Q

How does the caudate appear on a normal SPECT scan?

A

Symmetrical comma experience

43
Q

What are SPECT scan results in grade one Parkinson’s?

A

There is an asymmetrical loss of dopaminergic cells in the putamen

44
Q

What are SPECT scan results in grade two Parkinson’s?

A

There is bilateral loss of dopaminergic cells in the putamen

45
Q

What are SPECT scan results in grade three Parkinson’s?

A

There is bilateral loss of dopaminergic cells in the putamen and a reduction within the caudate

46
Q

What investigation can definitively diagnose Parkinson’s disease?

A

Post mortem biopsy

47
Q

What is a sign of Parkinson’s disease on biopsy?

A

Lewy bodies within the basal ganglia

48
Q

Who should initiate pharmacological management of Parkinson’s disease?

A

Specialists

49
Q

What are the five pharmacological management options of Parkinson’s disease?

A

Levodopa

Dopamine agonists

Monoamine oxidase-B (MAO-B) inhibitors

Catechol-O-methyltransferase (COMT) inhibitors

Antimuscarinics

50
Q

What is levodopa?

A

It is a precursor of synthetic dopamine, which converts into dopamine once it crosses the blood brain barrier

51
Q

When do we prescribe levodopa to manage Parkinson’s?

A

In cases where clinical features impose on the patient’s quality of life, it is recommended as the first line management option

It is also recommended once other pharmacological options have been deemed ineffective

52
Q

What do we usually prescribe with levodopa? Why?

A

Peripheral decarboxylase inhibitors

These drugs prevent levodopa being broken down in the body before it reaches the blood brain barrier, and thus reduces side effect development

53
Q

Name two peripheral decarboxylase inhibitors

A

Carbidopa

Benserazide

54
Q

What is the drug name for combined levodopa and benserazide?

A

Co-Benyldopa

55
Q

What is the drug name for combined levodopa and carbidopa?

A

Co-Careldopa

56
Q

How effective is levodopa in managing the symptoms of Parkinson’s?

A

It is the most effective pharmacological management option

However, this efficacy decreases over time

57
Q

Why does levodopa become less effective with time?

A

This is due to the fact that as there is an increased loss in dopaminergic nerve cells in the brain, less absorption of the medication can occur

58
Q

What are the seven common side effects of levodopa?

A

‘On-Off Effect’

Dyskinesia

Nausea & Vomiting

Arrythmias

Postural Hypotension

Red Urine Discolouration

Psychosis

59
Q

What side effect occurs when the dosage of levodopa is deemed too high?

A

Dyskinesia

60
Q

What is dyskinesia?

A

It is defined as abnormal movements associated with excessive motor activity

61
Q

What are the three types of dyskinesia?

A

Dystonia

Chorea

Athetosis

62
Q

What is dystonia?

A

It refers to excessive muscle contraction leading to abnormal postures or exaggerated movements

63
Q

What is chorea?

A

It refers to abnormal involuntary movements that can be jerking and random

64
Q

What is athetosis?

A

It refers to involuntary twisting or writhing movements usually in the fingers, hands or feet

65
Q

Why do we not suddenly stop levodopa? What should be done instead?

A

It can result in acute dystonia

In individuals who take levodopa orally, we administer a dopamine agonist patch to gradually wean patients off

66
Q

What should be administered in cases where patients still suffer from clinical features despite optimal levodopa?

A

The addition of a dopamine agonist, MAO‑B inhibitor or catechol‑O‑methyl transferase (COMT) inhibitor as an adjunct

67
Q

What are dopamine agonists?

A

They mimic dopamine in the basal ganglia and stimulate the dopamine receptors

68
Q

When do we prescribe dopamine agonists to manage Parkinson’s?

A

When the Parkinson’s disease is not affecting the patient’s quality of life

69
Q

Name four dopamine agonists

A

Bromocriptine

Ropinirole

Cabergoline

Apomorphine

70
Q

How effective are dopamine agonists in managing the symptoms of Parkinson’s?

A

These drugs are less effective than levodopa in symptomatic relief

71
Q

How are dopamine agonists used to manage Parkinson’s?

A

They are usually recommended to delay the use of levodopa and are then used in combination with it to reduce the dose that is required to control symptoms

72
Q

What are the six common side effects of dopamine agonists?

A

Pulmonary Fibrosis

Retroperitoneal Fibrosis

Cardiac Fibrosis

Impulse Control Disorders

Daytime Drowsiness

Hallucinations

73
Q

Due to the side effects of fibrosis being associated dopamine agonists, what four investigations do we conduct?

A

ESR bloods

Creatinine bloods

ECHO

CXR

74
Q

What is impulse control disorder?

A

It involves development of addictive gambling, compulsive shopping and excessively increased interest in sex

75
Q

What are monoamine oxidase enzymes?

A

They break down neurotransmitters, such as dopamine, serotonin and adrenaline

76
Q

What is the function of monoamine oxidase-B (MAO-B)?

A

It acts specifically to break down dopamine and does not act on serotonin or adrenaline

77
Q

What is the function of MAO-B inhibitors?

A

They inhibit MAO-B and therefore prevent the breakdown of dopamine

78
Q

Name two MAO-B inhibitors

A

Selegiline

Rasagiline

79
Q

How effective are MAO-B inhibitors in managing the symptoms of Parkinson’s?

A

These drugs are less effective than levodopa in symptomatic relief

80
Q

How are MAO-B inhibitors used to manage Parkinson’s?

A

They are usually recommended to delay the use of levodopa and are then used in combination with it to reduce the dose that is required to control symptoms

81
Q

What are COMT enzymes?

A

They metabolise levodopa in the brain and body

82
Q

What drug class do COMT inhibitors belong to?

A

Decarboxylase drugs

83
Q

What is the function of COMT inhibitors?

A

They prevent the breakdown of levodopa within the body

84
Q

Name two COMT inhibitors

A

Entacapone

Tolcapone

85
Q

When are COMT inhibitors used to manage Parkinson’s?

A

They are recommended in individuals who are in the later stages of Parkinson’s disease

86
Q

What are antimuscarinics?

A

They are involved in the inhibition of cholinergic receptors

87
Q

Name three antimuscarinics

A

Procyclidine

Benzotropine

Benzhexol

88
Q

How are antimuscarinics used to manage Parkinson’s?

A

They are used to treat drug-induced parkinsonism, specifically relieving clinical features of tremor and rigidity

89
Q

What is the aim of Parkinson’s management?

A

There is currently no cure for Parkinson’s disease

The aim of management is to relieve clinical features, maintain the patient’s quality of life and fulfil their wishes with disease progression

90
Q

What phenomenon do patients experience during pharmacological management of Parkinson’s?

A

On-off phenomenon

91
Q

What is the on-off phenomenon?

A

It describes motor performance being varied throughout treatment

The ‘on’ phase refers to periods in which normal motor function is obtained and the ‘off’ phase refers to periods in which there is restricted motor function

92
Q

What are Parkinson’s plus syndromes?

A

They are defined as a group of neurodegenerative diseases that feature the classical motor symptoms of Parkinson’s disease, with additional features that distinguish them from idiopathic Parkinson’s disease

93
Q

Name four Parkinson’s plus syndromes

A

Multiple System Atrophy (MSA)

Lewy Body Dementia

Progressive Supranuclear Palsy (PSP)

Corticobasal Degeneration (CBS)

94
Q

What is MSA?

A

It is a rare condition in which there is degeneration of neurones in multiple systems of the brain

It tends to affect the basal ganglia as well as multiple other areas of the brain

95
Q

What are the five clinical features associated with MSA?

A

Parkinson’s

Tachycardia

Syncope

Erectile Dysfunction

Cerebellar Dysfunction

96
Q

What is Lewy body dementia?

A

It is a condition in which there is an accumulation of Lewy bodies, which are deposits of alpha synuclein proteins, within the brain

97
Q

What are the four clinical features associated with Lewy body dementia?

A

Parkinsonism

Visual hallucinations

Fluctuations in cognitive impairment

Sleep disturbances

98
Q

What is progressive supranuclear palsy (PSP)?

A

It is defined as neurodegeneration that results in increased level of the tau protein within the brain

The tau protein is usually broken down before it reaches high levels, however in PSP this physiological process doesn’t occur, and levels increase above threshold

99
Q

What are the four clincial features associatde with progressive supranuclear palsy?

A

Postural Instability

Vertical Gaze Impairment

Parkinsonism

Frontal Lobe Dysfunction

100
Q

What clinical feature differentiates PSP from idiopathic Parkinson’s?

A

Eye movement abnormalities

101
Q

What is corticobasal degeneration (CBS)?

A

It is defined as neurodegeneration that results in increased level of the tau protein within the cerebral cortex and basal ganglia

The tau protein is usually broken down before it reaches high levels, however in PSP this physiological process doesn’t occur, and levels increase above threshold

102
Q

What two clinical features differentiate CBS from idiopathic Parkinson’s?

A

Cognitive impairment

Unilateral apraxia

103
Q

What is apraxia?

A

It refers to the inability to perform learned movements on command, even though the command is understood and there is a willingness to perform the movement

Year Two - Neurology System (25 decks)

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