Parkinson's Disease Flashcards
what is parkinson’s disease?
- sporadic disease of adults >65 years
- presents with asymmetric tremor and bradykinesia
what are the core features of parkinson’s disease?
- bradykinesia
- asymmetric ‘pill-rolling’ tremor (resting 3-5Hz tremor, reduced on action)
- lead pipe rigidity
- postural instability (late feature)
describe the bradykinesia in parkinson’s disease
slow movement
* short, shuffling steps with reduced arm swinging
* difficulty in initiating movement
poverty of movement also seen (hypokinesia)
describe the tremor seen in parkinson’s disease
- marked at rest, 3-5Hz
- worse when stressed or tired
- improves with voluntary movement
- typically ‘pill-rolling’ - in the thumb and index finger
what is cogwheeling?
lead pipe rigidity + tremor –> cogwheeling
jerkiness felt when testing a patient’s tone
what is the typical features of the gait in parkinson’s disease?
- small, shuffling steps
- slowness of movement (especially on initiation of movement and on turning)
- flexed posture
- asymmetric tremor
what is festination?
tendency to pick up speed as patient travels in a particular direction
seen in parkinson’s disease
what are the autonomic features of parkinson’s disease?
- constipation
- symptomatic orthostasis (postural hypotension)
- erectile dysfunction
what non-motor features are seen in parkinson’s disease?
- autonomic involvment
- olfactory loss
- REM behavioural disorder
- psychiatric features
- fatigue
- low and monotone voice
- hypomimic facies
what is REM behavioural disorder?
patient performs violent re-enactments of their dreams during REM phase sleep
what psychiatric features are seen in parkinson’s disease?
- depression
- anxiety
- hallucinations
- cognitive abnormalities
what medication can be prescribed in parkinson’s disease when people have functional impairment?
levodopa
what types of medications are used in parkinson’s disease?
- levodopa
- dopamine agonists
- monoamine oxidase inhibitors
- COMT inhibitors
what are the common side-effects of levodopa?
- hypotension
- restlessness
- GI upset
- drug-induced dyskinesias
- dopamine excess can result in psychiatric reactions including acute psychosis
what can be prescribed alongside levodopa to reduce the peripheral side-effects?
peripheral dopa decarboxylase inhibitor (e.g. carbidopa)
how long does it take to develop complete loss of response to levodopa?
2-5 years
what is rotigotine?
- dopamine agonist used to treat parkinson’s disease
- associated with impulse control disorder
what are the symptoms of dopamine agonist withdrawal syndrome (DAWS)?
- anxiety
- panic attacks
- dysphoria
- depression
- agitation
- irritability
- suicidal ideation
- fatigue
- orthostatic hypotension
- nausea
- vomiting
- diaphoresis
- generalised pain
- drug cravings
occurs when dopamine agonists are stopped too abruptly
what is parkinson’s disease caused by?
degeneration of the substantia nigra
what is progressive supranuclear palsy?
- parkinsonism
- vertical gaze palsy
parkinson-plus syndromes
what are the parkinson-plus syndromes?
- progressive supranuclear palsy
- multiple system atrophy
- cortico-basal degeneration
- lewy body dementia
what is parkinsonism?
- resting tremor
- hypertonia
- bradykinesia
what is multiple system atrophy?
- parkinsonism
- early autonomic clinical features - postural hypotension, incontinence, impotence
parkinson-plus syndrome
what is cortico-basal degeneration?
- parkinsonism
- spontaneous activity by an affected limb or akinetic rigidity of that limb
parkinson-plus syndrome
