Parkinson's Disease

Question 1

What causes Parkinson’s disease?

Answer 1

a progressive reduction in dopamine in the basal ganglia, leading to disorders of movement

Question 2

Are Parkinson’s symptoms symmetrical or asymmetrical?

Answer 2

asymmetrical (one side of the body is affected more than the other)

Question 3

What is the symptom triad of Parkinson’s disease?

Answer 3

1) resting tremor (tremor that is worse at rest)
2) rigidity (resisting passive movement)
3) bradykinesia (slowness of movement)

Question 4

What is the role of the basal ganglia?

Answer 4

coordinating habitual movements (walking, controlling voluntary movements and learning specific movement patterns)

Question 5

What is the frequency of a Parkinson tremor?

Answer 5

4-6 Hertz

Question 6

What is meant by the term “pill rolling tremor”?

Answer 6

the patient’s tremor resembles a pill being rolled between the finger tips and thumb

Question 7

Is a Parkinson tremor worse in movement or in rest?

Answer 7

rest

Question 8

Does a Parkinson tremor improve in movement or rest?

Answer 8

movement

Question 9

Describe the key differences between a Parkinson tremor and a benign essential tremor:

Answer 9

1) benign essential tremors are symmetrical
2) benign essential tremors are faster (6-8 hertz)
3) benign essential tremors improve at rest and are worse with movement
4) benign essential tremors improve with alcohol consumption while this makes no difference to the Parkinson tremor

Question 10

What type of rigidity is commonly seem in Parkinson’s disease?

Answer 10

cog wheel rigidity

Question 11

Give 6 presentations of bradykinesia seen in Parkinson’s disease:

Answer 11

1) micrographia (small handwriting)
2) shuffling gait
3) hypomimia (reduced facial expressions)
4) difficulty turning around
5) difficulty initiating movement
6) festinating gait (rapid frequency of gait to compensate for small steps)

Question 12

What is hypomimia?

Answer 12

reduced facial movement and facial expressions

Question 13

Give 6 symptoms of Parkinson’s that are not part of the triad:

Answer 13

1) anosmia (loss of sense of smell)
2) depression
3) postural instability
4) memory problems
5) sleep disturbances and insomnia
6) cognitive impairment

Question 14

Give two examples of Parkinson’s plus syndromes:

Answer 14

1) multiple systems atrophy
2) Lewy Body dementia

Question 15

What are Parkinson plus syndromes?

Answer 15

diseases that have features of Parkinson’s with unique additional symptoms

Question 16

What is multiple systems atrophy?

Answer 16

where neurons of various systems in the brain degenerate including the basal ganglia which can cause a Parkinson’s presentation while degeneration in other areas creates autonomic dysfunction (postural hypotension, constipation, sexual dysufnction)

Question 17

Give 3 presentations associated with autonomic dysfunction:

Answer 17

1) postural hypotension
2) constipation
3) sexual dysfunction

Question 18

What criteria is used to diagnose Parkinson’s disease?

Answer 18

The UK Parkinson’s Disease Brain Bank Clinical Diagnostic Criteria

Question 19

What is the name of the synthetic dopamine tablet used to treat Parkinson’s?

Answer 19

Levodopa

Question 20

What type of drug is given alongside Levodopa?

Answer 20

peripheral decarboxylase inhibitor

Question 21

Give two examples of peripheral decarboxylase inhibitor drugs:

Answer 21

1) carbidopa
2) benserazide

Question 22

What is the role of taking a peripheral decarboxylase inhibitor alongside Levodopa?

Answer 22

they prevent Levodopa from being metabolised in the body before it reaches the brain to increase its effectiveness

Question 23

What is the name of the combination drug that includes both Levodopa and benserazide?

Answer 23

Co-beneldopa

Question 24

What is the name of the combination drug that includes both Levodopa and carbidopa?

Answer 24

Co-careldopa

Question 25

What is they key side effect of taking Levodopa?

Answer 25

dyskinesia

Question 26

What is dyskinesia?

Answer 26

abnormal movements associated with excessive motor activity

Question 27

Give 3 types of dyskinesia:

Answer 27

1) Dystonia
2) Chorea
3) Athetosis

Question 28

What is dystonia?

Answer 28

excessive muscle contraction causing abnormal postures and exaggerated movement

Question 29

What is chorea?

Answer 29

abnormal involuntary movements that can be jerking and random

Question 30

What is athetosis?

Answer 30

involuntary twisting or writhing movements, particularly in the fingers, hands or feet

Question 31

What drug can be given alongside Levodopa to reduce the side effect of dyskinesia?

Answer 31

amantadine

Question 32

What type of drug is amantadine?

Answer 32

glutamate antagonist

Question 33

What does COMT stand for?

Answer 33

catechol-O-methyltransferase

Question 34

How do COMT inhibitors manage Parkinson’s disease?

Answer 34

catechol-o-methyltransferase (COMT) enzymes metabolise Levodopa and so inhibition of this extends its effective duration

Question 35

Give an example of a COMT inhibitor:

Answer 35

entacapone

Question 36

Describe how dopamine agonists can help manage Parkinson’s disease:

Answer 36

they mimic the action of dopamine in the basal ganglia, stimulating dopamine receptors

Question 37

What is a key side effect of dopamine agonists?

Answer 37

pulmonary fibrosis

Question 38

Give 3 examples of dopamine agonists:

Answer 38

1) bromocriptine
2) pergolide
3) cabergoline

Question 39

Describe how monoamine oxidase-B inhibitors can help manage Parkinson’s disease:

Answer 39

they block monoamine oxidase B enzymes which breakdown neurotransmitters such as dopamine, serotonin and adrenaline, hence increasing the amount of circulating dopamine

Question 40

Give 2 examples of monoamine oxidase-B inhibitors:

Answer 40

1) selegiline
2) rasagiline