Parkinson's Disease

Question 1

Pathological hallmark

Answer 1

Dopaminergic neuron loss in the substantia nigra pars compacta (SNpc), with a-synuclein containing Lewy bodies and Lewy neurites.

Question 2

Basal Ganglia

Answer 2

Parkinsonian Syndrome
Dystonia
Chorea - Ballismus

Question 3

Parkinsonian Syndrome

Answer 3

Rigidity
Akinesia / bradykinesia
Resting ‘pill rolling’ tremor

Question 4

Clinical Features

Answer 4

Tremor
Muscular rigidity
Akinesia
Rest tremor
Gait and postural impairment

Question 5

2 types of PD

Answer 5

Tremor dominant PD

Non-tremor dominant PD

Question 6

Non-motor features of PD

Answer 6

Olfactory dysfunction
Cognitive impairment
Psychiatric symtpoms
Sleep disorders
Autonomic dysfunction
Pain
Fatigue

Question 7

REM sleep behaviour disorder in PD treatment

Answer 7

Clozepam or melatonin at bedtime

Question 8

Neuronal loss in PD regions

Answer 8

Locus ceruleus
Nucleus basalis Meynert
Pedunculopontine
Raphe nuclei
Dorsal motor nucleus of vagus
Amygdala
Hypothalamus

Question 9

First gene to be associated with inherited PD in 1997

Answer 9

SNCA

Question 10

Most common cause of dominant and recessive PD

Answer 10

Dominant: LRRK2
Recessive: Parkin

Question 11

Greatest risk factor for PD

Answer 11

Mutation in GBA (encodes B-glucocerebrosidase)

Question 12

Drugs used in PD Treatment

Answer 12

Levodopa
Dopamine
Monoamine Oxydase Type B Inhibitors
Amantadine

Question 13

Bradykinesia and Rigidity

Answer 13

Respond to Dopaminergic treatment early in disease

Question 14

MAOB Inhibitors

Answer 14

Only moderately effective, Levodopa and dopamine agonists needed for more severe symptoms

Question 15

Tremor

Answer 15

Responds inconsistently to Dopamine replacement therapy.

Question 16

Anticholinergics

Answer 16

Useful for tremor. Trihexyphenidyl, or clozapine also work

Question 17

Adverse drug reactions (Dopamine agonists and Levodopa)

Answer 17

Nausea, daytime somnolence and oedema.

Question 18

Dopamine agonists avoided in

Answer 18

Patients with history of addiction, OCD and impulsivity disorder.

Question 19

Adverse drug reactions (Dopamine agonists)

Answer 19

Associated with hallucinations - should not be prescribed in the elderly, especially those with cognitive impairment.

Question 20

Adverse drug reactions (Levodopa - long term use)

Answer 20

Long term use is associated with motor complications (dyskinesia and motor fluctuations)

Question 21

Long-term complications of dopaminergic therapies for PD

Answer 21

Motor fluctuations
Non-motor fluctuations
Dyskinesia
Drug induced psychosis

Question 22

Management of complications of long term dopaminergic therapies

Answer 22

Strategies to reduce dopamine fluctuations:
Dopamine agonist
MAOB inhibitor
Catecholo-O-methyltransferase (COMT) inhibitor - entacapone
Psychosis in PD is managed with clozapine (or quetiapine)

Question 23

Depression in PD patients

Answer 23

SSRIs

TCA

Question 24

Visual hallucinations in PD

Answer 24

Cholinesterase inhibitors, such as Rivastigmine, can reduce hallucinations.

Question 25

Late stage dementia in PD

Answer 25

Tx: Rivastigmine

Question 26

Dopamine Agonist examples

Answer 26

Cabergoline
Bromocriptine
Ropinirole
Pergolide

Question 27

Bromocriptine

Answer 27

Dopamine receptor agonist used when levodopa therapy is not adequate or not well tolerated.

Question 28

Selegiline

Answer 28

MAO-B inhibitor - enzyme for which dopamine is a substrate. Reduces the metabolism of dopamine in the brain and potentiates the action of L-dop.
Effective early and late in the disease.

Question 29

Benzatropine

Answer 29

Muscarinic antagonist.

Useful for when resting tremor is the predominant symptom.