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
what is lewy body dementia?
- parkinsonism
- fluctuations in cognitive impairment
- visual hallucinations
parkinson-plus syndrome
what is apraxia?
not being able to follow instructions, but being able to do them automatically
what condition can cause apraxia?
corticobasal degeneration
what is postural hypotension?
fall in blood pressure of at least 20mmHg systolic and 10mmHg diastolic within 3 minutes in the upright position
how does drug-induced parkinsonism present?
- motor symptoms are generally rapid onset and bilateral
- rigidity and rest tremor are uncommon
what medications should be avoided in parkinson’s disease?
antipsychotics
can worsen symptoms of parkinson’s disease
