Parkinson's Disease

Question 1

PD epidemiology

Answer 1

0.3% prevalence in general population
effects more males than females

Question 2

parkinsonism

Answer 2

bradykinesia
rigidity
rest tremor
postural instability/gait disorder

Question 3

essential tremor

Answer 3

most common movement disorder
autosomal dominant
tremor absent at rest, persists during movement
usually attenuated by alcohol

Question 4

What does a dopamine transport scan do?

Answer 4

visualize PD pathology

Question 5

pathogenesis of PD

Answer 5

aggregation of alpha-synuclein: disrupts lysosomal membrane and creates Lewy bodies
prion-like cell to cell spread

Question 6

pathophysiology of PD

Answer 6

many mechanisms: mitochondrial dysfunction, decrease in protein degradation, apoptosis, synaptic pathobiology, calcium homeostasis, neuroinflammation, alpha-synuclein pathology
all lead to cell death

Question 7

motor symptoms of PD

Answer 7

due to loss of nigrostriatal dopamine neurons
dopamine deficiency
at time of diagnosis: patients have 40% of normal DA neuron number

Question 8

treatment of PD motor symptoms

Answer 8

levodopa: becomes DA in the brain
DA agonists: imitates DA
MAO-B inhibitors: reduces breakdown of DA
DBS

Question 9

non-motor PD symptoms

Answer 9

due to deficiencies in DA, NE, 5HT, ACh
cognitive, psychiatric, visual, autonomic, sleep

Question 10

types of cognitive/mental PD symptoms

Answer 10

executive functions: planning, decision making, judgement, flexibility, multitasking
attention
visuospatial perception
memory
language

Question 11

stages of cognitive impairment in PD

Answer 11

mild: can still function and live independently, occurs in more than 50% of patients
dementia: impairment in at least two cognitive domains, significant loss of function affecting independence, occurs in more than 80% of patients who have had the disease for more than 20 years

Question 12

What is the diagnosis if patients present with cognitive and PD symptoms?

Answer 12

dementia with Lewy bodies

Question 13

depression and anxiety in PD

Answer 13

common: 50-60% of patients
can be more disabling that motor symptoms
symptoms can fluctuate with medication cycles

Question 14

impulse control disorders in PD

Answer 14

about 15% prevalence
cumulative incidence of DA agonist medication and impulse control: greatly reduced at discontinuation
pathological gambling, compulsive buying, sexual behaviors, binge eating
risk factors: less than 65 years old, single, smoker, gambling in family

Question 15

dopamine dysregulation syndrome

Answer 15

motor responsiveness to DA medications
addicted to medication
impairment in social or occupational functioning
development of manic reactions to DA medications, withdrawal symptoms if discontinued
seen more often in younger patients

Question 16

psychosis in PD

Answer 16

minor illusions
hallucinations
delusions

Question 17

treatment for non-motor symptoms in PD

Answer 17

similar to treatment in general population
avoid medications that can worsen motor symptoms

Question 18

motor fluctuations in PD

Answer 18

levodopa effects vary of the course of PD
as time goes on: the therapeutic effect and time decreases while dyskinesia increases
DBS can “reset” the medication course and make levodopa more effective again

Question 19

candidacy for DBS in PD

Answer 19

idiopathic: no atypical parkinsonism
disabling and medically refractory motor fluctuations, dyskinesia
preserved responsiveness to dopaminergic medication
no medication or psychiatric disease
no disabling condition
supportive social environment