Parkinson's disease Flashcards
What are the four main features of Parkinson’s disease?
- pill rolling resting tremor (index finger and thumb)
- bradykinesia (slow movement)
- rigidity (increased tone)
- postural instability
What are other features of Parkinson’s disease?
- depression
- sleep disturbance
- cognitive impairment and memory problems
- micrographia (small writing)
- loss of smell
What are the defining features of Parkinson’s disease?
- pill rolling resting tremor
- worse at rest
- reduced on movement
- reduced on distraction
- asymmetrical
What is the pathophysiology of Parkinson’s disease?
it is where there is a loss of the dopaminergic neurone in the substantial nigra in the basal ganglia- leading to a loss of dopamine
What are the main differences between Parkinson’s and benign essential tremor
Parkinsons is asymmetrical, BET is symmetrical.
Parkinson’s is worse at rest and BET improves at rest.
Parkinson’s has no change with alcohol but BET improves with alcohol
What does a typical Parkinson’s patient look like?
What are the Parkinson’s plus syndromes?
- Dementia with Lewy bodies
- multiple system atrophy
- progressive supra nuclear palsy
- corticobasal degeneration
What is multiple system atrophy?
A rare condition where various systems in the brain degenerate (inc. basal ganglia) leading to Parkinson’s presentation as well as autonomic and cerebellar dysfunction
What are the signs of autonomic dysfunction?
- postural hypotension
- constipation
- abnormal sweating
- sexual dysfunction
What are the signs of cerebellar dysfunction?
Ataxia- affects coordination, balance and speech
How do you diagnose Parkinson’s disease?
Clinical findings
What is the treatment of Parkinson’s?
- levodopa (combined with peripheral decarboxylase inhibitors)
- COMT inhibitors
- dopamine agonists
- monoamine oxidase-B inhibitors
What is levodopa?
synthetic dopamine which is the most effect treatment for symptoms but becomes less effective overtime so is used towards the end. Combined with peripheral decarboxylase inhibitors which stop it being metabolised in the body before it reaches the brain.
What are COMT inhibitors?
catechol-o-methyltransferase enzyme metabolises levodopa in both the body and brain so the inhibitor slows down the breakdown of levodopa in the brain, extending the effective duration
What are dopamine agonists?
They mimic the action of dopamine in the basal ganglia- stimulation the dopamine receptors.
Less effective than Ldopa but used to delay the use of Ldopa.
- bromocriptine, pergolide, cabergoline
