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CM Clinical Symposia > Parkinson's disease 2 > Flashcards

Parkinson's disease 2 Flashcards

1
Q

Epidemiology

A

1 in 500 adult population, 1% 65 year olds

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2
Q

Risk factors

A
  • Advancing age
  • Male (3:2)
  • Caucasians > Asians and Africans
  • Rural living and farmers (pesticides)
  • Family history
  • Previous head injury
  • Idiopathic
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3
Q

Protective factors

A

Smoking and caffeine

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4
Q

Parkinsonism

A

Clinical syndrome comprising of bradykinesia (and one of..) Tremor, rigidity, postural instability

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5
Q

Biggest cause of parkinsonism?

A

Parkinson’s disease

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6
Q

How do you diagnose?

A

Pathology in brainstem and basal ganglia - Lewy bodies and neuronal degeneration (asymmetry, sustained response to levodopa)

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7
Q

Degenerative brain disorders caused by

A

Abnormal aggregation

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8
Q

Specifically in Parkinsons protein that aggregates is

A

Alpha-synuclein

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9
Q

Neurodegenerative causes of parkinsonism

A

Parkinson’s disease (PD), Lewy Body dementia (LBD), Progressive supra nuclear palsy (PSP), Multiple system atrophy (MSA)

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10
Q

2nd most common cause of Parkinsonism

A

Drug-induced

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11
Q

Drug-induced causes of parkinsonism

A

Dopamine antagonists (anti-psychotics, anti-emetics), Sodium valproate, MPTP

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12
Q

Other causes of parkinsonism

A

Vascular disease (stroke) and Metabolic (Wilson’s disease)

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13
Q

Wilson’s disease

A

Copper deposition in brain and liver

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14
Q

Bradykinesia

A

Slowed gait with shuffling steps, reduced facial express and blinking (hypomimia), reduced gesticulation, small handwriting (hypographia)

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15
Q

PD gait

A

Difficulty initiating, slowed pace, small steps, stooped flexed posture, festinating, several steps to turn, reduced arm swing, freezing, turn on block

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16
Q

Tremor

A

70%, begins in one hand, spreads bilaterally, rest tremor, reduces/disappears with action, leg and jaw tremors seen, ‘pill rolling’, distraction brings out tremor

17
Q

Rigidity

A

Stiffness, ‘lead pipe’ rigidity, co-activation brings it out

18
Q

Cogwheeling

A

Combination of rigidity and tremor

19
Q

Other clinical features

A

Anosmia, sleep disturbances (REM behaviour disorder), hypophonia, dysphagia, dystonia, constipation and urinary disturbance, autonomic disturbance, depression and anxiety, dementia

20
Q

Less dopamine leads to

A

Abnormal movements

21
Q

Imaging

A

CT/MRI - normal

22
Q

DaTscan (FP-CIT SPECT)

A

Nuclear medicine scan - inject tracer that binds to dopaminergic neurones (normal in central tremor and drug induced)

23
Q

Problems with DaTscan

A

Expensive, Ionising radiation, cannot differentiated between PD and PD+ syndromes, (not specific), not widely available, takes a full day

24
Q

DaTscan (FP-CIT SPECT)

A

Normal - comma

PD - full stop

25
Q

Non-pharmacological treatment

A

Physio, OT, speech and language therapy

26
Q

Dopamine agonist

A

Gets cells left to work harder (ropinerole, pramipexole, rotigotine, apomorphine)

27
Q

L-Dopa

A

Pre-cursor of dopamine (Co-careldopa, Co-beneldopa, Duodopa (PEJ)

28
Q

MAO-I

A

Rasagiline, selegiline

29
Q

COMT-I

A

Entacapone, tolcapone

30
Q

PD drugs

A

Increase dopaminergic stimulation to improve movements, tremor rigidity, increase ‘on’ periods and reduce ‘off’ periods

31
Q

Too much dopaminergic stimulation

A

Abnormal movements (dyskinesia), confusion, hallucinations, impulse control disorders

32
Q

Impulse control disorders

A

Hyper sexuality, gambling, excessive eating, failure to resist temptation, urge or impulse

33
Q

Advance PD treatments

A
  1. Apomorphine (sb injection)
  2. Duodopa (L-dopa gel via PEJ tube)
  3. Deep brain stimulation (inhibits parts of basal ganglia)
34
Q

Apomorphine

A

Potent dopamine agonist, skin nodules, similar adverse effects to other dopamine agonists, several months to find optimal dose (£10,000/year)

35
Q

Duodena

A

16 hours a day straight into stomach (£30,000/year)

36
Q

Deep brain stimulation

A

Risks 1% stroke, 2-4% infection

37
Q

Prognosis

A
  1. Maintenance 5-10yr
  2. Complex 5 yr (swallowing)
  3. Palliative 3 yr (dementia, death)
38
Q

What is commonest cause of death in PD?

A

Pneumonia

CM Clinical Symposia (24 decks)

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