Parkinson's disease Flashcards
What is Parkinson’s disease?
Parkinson’s disease is a progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra.
What are the classical features of Parkinson’s disease?
The classical triad of features includes bradykinesia, tremor, and rigidity.
How are the symptoms of Parkinson’s disease characterized?
The symptoms are characteristically asymmetrical.
What is the epidemiology of Parkinson’s disease?
It is around twice as common in men, with a mean age of diagnosis at 65 years.
What is bradykinesia?
Bradykinesia refers to poverty of movement, sometimes called hypokinesia, characterized by short, shuffling steps with reduced arm swinging and difficulty in initiating movement.
What is a key feature of tremor in Parkinson’s disease?
The tremor is most marked at rest, typically ‘pill-rolling’ between the thumb and index finger.
How does tremor change with stress or movement?
The tremor worsens when stressed or tired and improves with voluntary movement.
What are the types of rigidity associated with Parkinson’s disease?
Rigidity can be described as lead pipe or cogwheel, the latter due to superimposed tremor.
What are other characteristic features of Parkinson’s disease?
Other features include mask-like facies, flexed posture, micrographia, drooling of saliva, and psychiatric features such as depression.
What psychiatric features are common in Parkinson’s disease?
Depression is the most common feature, affecting about 40%, along with possible dementia, psychosis, and sleep disturbances.
What autonomic dysfunctions can occur in Parkinson’s disease?
Autonomic dysfunction can include postural hypotension.
How does drug-induced parkinsonism differ from Parkinson’s disease?
In drug-induced parkinsonism, motor symptoms are generally rapid onset and bilateral, with rigidity and rest tremor being uncommon.
How is Parkinson’s disease diagnosed?
Diagnosis is usually clinical, but if differentiating between essential tremor and Parkinson’s disease is difficult, 123I-FP-CIT SPECT is recommended.
Who should diagnose and manage Parkinson’s disease?
Parkinson’s disease should only be diagnosed and managed by a specialist with expertise in movement disorders.
What did NICE publish in 2017 regarding Parkinson’s disease?
NICE published guidelines regarding the management of Parkinson’s disease.
What is the first-line treatment for Parkinson’s if motor symptoms affect quality of life?
Levodopa.
What is the first-line treatment for Parkinson’s if motor symptoms do not affect quality of life?
Dopamine agonist (non-ergot derived), levodopa, or monoamine oxidase B (MAO-B) inhibitor.
What are the effects of Levodopa on motor symptoms and activities of daily living?
Levodopa provides more improvement in motor symptoms and activities of daily living.
What are the effects of dopamine agonists on motor symptoms and activities of daily living?
Dopamine agonists provide less improvement in motor symptoms and activities of daily living.
What are the common adverse events associated with Levodopa?
Common adverse effects include dry mouth, anorexia, palpitations, postural hypotension, and psychosis.
What should be done if a patient continues to have symptoms despite optimal levodopa treatment?
Consider adding a dopamine agonist, MAO-B inhibitor, or catechol-O-methyl transferase (COMT) inhibitor as an adjunct.
What is the risk associated with not taking Parkinson’s medication?
There is a risk of acute akinesia or neuroleptic malignant syndrome.
What should be considered if excessive daytime sleepiness develops in Parkinson’s patients?
Patients should not drive, and medication should be adjusted to control symptoms.
What medication can be considered for orthostatic hypotension in Parkinson’s patients?
Midodrine can be considered if symptoms persist.
What is the common combination for Levodopa treatment?
Levodopa is nearly always combined with a decarboxylase inhibitor (e.g., carbidopa or benserazide).
What are the side effects of dopamine receptor agonists?
Side effects include impulse control disorders, excessive daytime somnolence, hallucinations, nasal congestion, and postural hypotension.
What is the mechanism of action for MAO-B inhibitors?
MAO-B inhibitors inhibit the breakdown of dopamine secreted by the dopaminergic neurons.
What are the side effects of Amantadine?
Side effects include ataxia, slurred speech, confusion, dizziness, and livedo reticularis.
What is the role of COMT inhibitors in Parkinson’s treatment?
COMT inhibitors are used as an adjunct to levodopa therapy.
What are antimuscarinics used for in Parkinson’s disease?
Antimuscarinics help treat tremor and rigidity.
