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Neurology > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What are the four cardinal features of Parkinson’s disease?

A
  • tremor
  • Bradykinesia
  • Rigidity
  • Postural instability
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2
Q

What is the initial complaint in most parkinson’s patients?

A

Tremor

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3
Q

Is the tremor with Parkinson’s disease a resting or intention tremor? does it usually onset as a unilateral or bilateral tremor?

A

Resting-unilateral

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4
Q

True or false: most patients with tremors are usually from Parkinson’s

A

Very false–many patients are idiopathic

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5
Q

What happens to all tremors with sleeping, including parkinson’s?

A

Goes away

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6
Q

What is usually the most disabling feature of Parkinson’s disease?

A

Bradykinesia

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7
Q

What is the cause of the freezing with Parkinson’s disease?

A

Dopaminergic

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8
Q

What happens to the speech with Parkinson’s? What is the simple technique that can be used to decrease this?

A

Low volume

Sing in the shower

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9
Q

What is the rigidity like with Parkinson’s disease?

A

Resistance to PROM “cogwheel” component (feels like a ratchet d/t tremor imposed on rigidity)

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10
Q

What is antepulsion and retropulsion with Parkinson’s?

A

Inability to stop once moving in forward/backward direction, or make rapid adjustments in posture

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11
Q

What are the three major autonomic dysfunctions with Parkinson’s?

A
  • Postural hypotension
  • Hyperhidrosis
  • Bowel/bladder dysfunction
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12
Q

What percent of Parkinson’s patients have dementia?

A

20-80%

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13
Q

True or false: If you have dementia within a year of onset with parkinson’s, you most likely do not have Parkinson’s, but some other disease

A

True

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14
Q

Mask-like facies = what disease?

A

Parkinson’s

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15
Q

What is the classic Parkinsonian posture?

A

Flexed posture

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16
Q

What, besides dementia, are the cognitive effects of Parkinson’s?

A

Hypersexuality

Gambling issues

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17
Q

What generally happens to sleep with Parkinson’s?

A

Decreased amount

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18
Q

What is the pathophysiology of Parkinson’s disease?

A

Degeneration of basal ganglia–specifically the zona compacta of the substantia nigra

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19
Q

What happens to the substantia nigra with Parkinson’s?

A

Loss of it d/t loss of dopaminergic neurons

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20
Q

What are Lewy bodies? Where are they particularly found?

A

Alpha synuclein eosinophilic inclusion

Zona compacta

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21
Q

What sense is lost particularly early with Parkinson’s? Why?

A

Smell d/t loss of olfactory neurons

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22
Q

What is the protein that is stained for with Parkinson’s, to locate Lewy bodies? What is the role of this in PD?

A

Ubiquitin–may be toxic to brain

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23
Q

True or false: Parkinson’s is a cortical dysfunction?

A

False–BG dysfunction.

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24
Q

What is the cortical input to the caudate nucleus?

A

Feeds through the putamen, globus pallidus, and thalamus…BACK TO CORTEX

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25
Q

What are the components of the striatum? What is its major function?

A
  • Caudate nucleus
  • Putamen

-Reward system

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26
Q

What is the neurotransmitter used within the BG?

A

Acetylcholine

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27
Q

What is the area of the brain that turns off the BG? What is the neurotransmitter here?

A

Substantia nigra

Dopa

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28
Q

What parts of movement do the BG control?

A

Initiation and termination

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29
Q

What is problem with Huntington’s disease?

A

Loss of the caudate nucleus

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30
Q

What are the degenerative diseases that can manifest like Parkinson’s disease?

A
  • Huntington’s disease

- Spinocerebellar degeneration

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31
Q

What is hypoxemic Parkinsonism?

A

Hypoxia of the substantia nigra leads to a PD like state

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32
Q

What is the major drug class that can cause Parkinsonism?

A

-Dopamine receptor blockers (e.g. antipsychotics, haloperidol, thorazine, Li)

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33
Q

What is the GI motility drug that can induce Parkinsonism?

A

Metoclopramide

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34
Q

What is the antiemetic drug that can induce Parkinsonism?

A

Chlorpromazine

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35
Q

What is the anticonvulsant drug that can induce Parkinsonism?

A

Valproic acid

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36
Q

What are the two antiHTN drugs that may cause Parkinson’s?

A

Reserpine

Alpha-methyldopa

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37
Q

What metal can cause Parkinsonism?

A

Mn

38
Q

What is the gaseous toxin that can cause Parkinsonism?

A

CO

39
Q

What are the liquid toxins that can cause Parkinson-like Disease?

A

Methanol/ethanol

40
Q

What is the narcotic drug that can cause Parkinson-like disease?

A

MPTP (methyl-phenyl tetrahydropyridine)

41
Q

What is the MOA of selegiline? Use?

A
  • MAO-B inhibitor

- Used in combination with L-DOPA to decrease the breakdown of L-DOPA

42
Q

What is normal pressure hydrocephalus? S/sx (classic triad)?

A
  • Failure of reabsorption of CSF causes increased volume of the ventricles
  • Lethargy, gait disorder, and urinary incontinence
43
Q

What is the classic triad of s/sx with NPH?

A
  • Lethargy
  • Magnetic gait
  • Incontinence of urine
44
Q

What are the three inclusion criteria for PD? How many are needed?

A
  • Bradykinesia
  • Muscular rigidity
  • Postural instability

2/3

45
Q

What are the 5 supportive criteria for PD?

A
  • unilateral onset
  • Resting tremor
  • Progressive disorder
  • Excellent response to L-DOPA
  • Clinical course over 10 years
46
Q

True or false: you do not make a diagnosis based on response to treatment

A

True

47
Q

True or false: multiple strokes or head trauma are exclusion criteria for PD

A

True

48
Q

Unilateral disease lasting longer than how long is a PD exclusion criteria?

A

3 years

49
Q

What are the oculomotor manifestations that is an exclusion criteria for PD?

A
  • Supra-nuclear gaze palsy

- Oculogyric crisis

50
Q

True or false: PD should never have cerebellar signs

A

True–exclusion criteria

51
Q

True or false: early autonomic dysfunction is common with PD

A

False–exclusion criteria

52
Q

True or false: MPTP exposure is an exclusion criteria for PD

A

True

53
Q

Which gender is usually affected more with PD?

A

Both equally

54
Q

What percent of PD is familial? What are the possible other causes?

A

10%

-Oxidative stress and environmental risk factors

55
Q

What are the two protective factors against PD?

A
  • Exercise

- Smoking

56
Q

What are the two putative factors for PD?

A
  • Constipation
  • Head injury
  • Depression
  • Beta-blockers use
57
Q

How do you diagnose PD?

A

H and P

58
Q

What may an MRI show with parkinson’s?

A

May show hypodensity Fe++ in the basal ganglia

59
Q

What are the four major medications that are used to treat Parkinson’s?

A
  • Anticholinergics
  • Dopaminergic agents
  • COMT/MAO-B inhibitors
  • L DOPA
60
Q

What is the classic anticholinergic drug used to treat PD?

A

Benztropine

61
Q

What are the three major dopaminergic drugs used to treat PD?

A
  • Amantadine
  • Ropinirole
  • Apomorphine
62
Q

What are the COMT inhibitors that are used in conjunction with L-DOPA? Which acts centrally, and which acts peripherally?

A

Entacapone–peripherally

Tolcapone–centrally

63
Q

What are the two major MAO-B inhibitors used in the treatment of PD?

A

Selegiline

Rasagiline

64
Q

What are the surgical options for PD?

A

Pallidotomy

Thalamotomy

65
Q

What is the role of the deep brain stimulator in the treatment of PD?

A

Turn off the overactive BG using HV/LA (high voltage, low-amplitude)

66
Q

What is the role of supplemental neuroprotective agents used to prevent PD?

A

Do not work

67
Q

What is the role of PT in the treatment of PD?

A

Can be equal to L-DOPA effect

68
Q

What is the problem with L-DOPA with absorption in the GI tract?

A

Competes with other amino acids

69
Q

What are the three neurotransmitters that are affected in Parkinson’s disease, and how are they affected?

A
  • Dopamine decreased
  • ACh increased
  • 5HT decreased
70
Q

Mutations in the gene encoding what enzyme is associated with an increased risk of developing Parkinson’s disease (hint: same as in Gaucher’s disease)?

A

Glucocerebrosidase

71
Q

Dopamine released from the substantia nigra act on what part of the brain?

A

Striatum

72
Q

What are the three major sequence processes that occur in the pathophysiology of Parkinson’s disease?

A
  1. D1 neurons no longer inhibit the internal segment of the globus pallidus
  2. Increased release of GABA from the pallidus to the thalamus
  3. Increased GABA to the thalamus leads to inhibition of movement
73
Q

What are the 5 drugs used to treat Parkinson’s?

A 
Bromocriptine
Amantadine
Levodopa/carbidopa
Selegiline
Antimuscarinics

(BALSA)

74
Q

What is the MOA of bromocriptine?

A

Dopamine receptor agonist

75
Q

What is the MOA of pramipexole?

A

Dopamine receptor agonist

76
Q

What is the MOA of ropinirole?

A

Dopamine receptor agonist

77
Q

What is the MOA of amantadine in the treatment of parkinson’s?

A

NMDA receptor antagonist causes an increased release of dopamine and decreased reuptake

78
Q

What is the MOA of carbidopa?

A

Inhibits DOPA-decarboxylase

79
Q

What is the MOA of selegiline?

A

MAOI B inhibitor used to decrease the breakdown of L-DOPA

80
Q

Is there weakness with PD?

A

Not usually, but low level of functioning may seem like it.

81
Q

What is the role of the caudate nucleus?

A

Input region of the BG, along with the putamen

82
Q

What are the components of the basal ganglia? (5)

A
  • Caudate nucleus
  • Putamen
  • Globus pallidus
  • Subthalamic nucleus
  • Substantia nigra
83
Q

What are the components of the striatum?

A

Caudate nucleus and putamen

84
Q

What is the effect of the substantia nigra on the striatum? How? What happens to this with PD?

A

Inhibits it though dopaminergic projections

Loss of inhibition of the BG leads to inability to move well

85
Q

True or false: dopa is usually an inhibitory neurotransmitter

A

True

86
Q

What is the MOA of metoclopramide?

A

Dopamine receptor antagonist and is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist.

87
Q

What is the classic brain scan findings with Huntington’s?

A

Enlargement of the ventricles, d/t loss of the caudate nucleus

88
Q

What is the usual result of the babinski test with PD?

A

Normal (downgoing)

89
Q

True or false: no response to L-DOPA is an exclusion criteria for PD

A

True

90
Q

What is the treatment for Restless leg syndrome?

A

Pramipexole

Neurology (23 decks)

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