Parkinson's Disease

Question 1

What is the Definition of Parkinson’s

Answer 1

Neurodegenerative disease caused by the death of dopamine-containing cells in the substantial nigra (origin of dopaminergic afferents)

Question 2

What is the pathophysiology of Parkinson’s

Answer 2

Loss of dopaminergic, serotonergic and noradrenergic neurons.

Question 3

What are the THREE genes affected in Parkinson’s

Answer 3

1) Alpha Synuclein - autosomal dominant
. Major constituent of lewy bodies, too much or abnormal
2) LRRK2 - autosomal dominant
. Leucine-rich repeat kinase 2
3) Parkin - autosomal recessive
acts as a ubiquitin-protein ligase (protective)

Question 4

What complex can be missing in people with PD

Answer 4

Mitochondrial complex 1 (extracts energy from NADH)

Question 5

Name some autonomic non-motor symptoms

Answer 5

GI - constipation
Genitourinary - urinary urgency, erectile dysfunction
Cardiovascular - sympathetic denervation
Cognitive - slow thoughts, dementia
Sleep - rapid eye movement, restless legs
Mood - depression, psychosis
Pain - muscoskeletal, radicular neuropathic, dystonic

Question 6

What is the first line therapy

Answer 6

LEVODOPA - bradykinesia and rigidity, converted to dopamine via DOPA-decarboxylase

Question 7

What is the first line therapy in younger patients

Answer 7

Dopamine agonists - reduced motor complication, selective for D2 and D3 post synaptic receptors

Question 8

How do MAO’s work

How do COMT inhibitors work

Answer 8

Prevents degradation of dopamine

Prevents degradation of dopamine

Question 9

How does deep brains stimulation work

Answer 9

Permanent implantation of leads into subthalmic nucleus or globes pallid us, deliver high frequency electrical impulses