Parkinson's disease Flashcards
Parkinson’s disease (PD) characteristics
Bradykinesia
Resting Intention Tremor
increased tone (rigidity)
Risk factors of PD
age and gender (over 80 1.5M:1F)
Environmental factors (pesticide exposure)
Genetic factors
other clinical features of PD
Depression Anxiety Cognitive impairment - develops in 1/3 of patients as disease progresses Speech Swallowing dribbling drooling of saliva mouth constipation bladder emptying
Indications of investigation for PD
Diagnosis is usually clinical
If pyramidal, cerebellar, or autonomic involvment is suspected request CT
of <50yrs rule out Willson’s and Huntington’s disease
Drug management of PD
Levodopa (Sinemet and Madopar) - main Rx, mainly improves bradykinesia and rigidity
Decarboxylase inhibitors (Carbidopa and benserazide) - reduce peripheral side effects. (Do not pass BBB)
dopamine receptor agonists - less powerful than levodopa
Monoamine oxidase type B (MAOIB) inhibitors - facilitates breakdown of dopamine in the synapse. (Not used anymore)
catechol-O-methyl-transferase (COMT) - when used with levodopa helps with to prolong effect of each dose and thus lower dose of levodopa
amantadine - useful in early presentation for bradykinesia
anticholinergics - not as useful anymore, could help in improving tone but meh
what is the difficulty with levodopa
late detoriaration - this occurs after 3-5 years of treatment with levodopa in 50% patients.
simplest form is end of dose detoriaration
improved by using smaller more frequent doses or slow release preparations
more severe forms have periods of bradykinesia or agitation “on-off effect”
non pharmacological Rx of PD
Surgery: deep brain stimulation
physiotherapy and speech therapy
commonest parkinsonism syndromes other than PD
cerebrovascular disease and drug induced parkinsonism
other parkinsonism syndromes
these are degenerative causes of parkinsonism that develop rapidly and are resistant to levodopa
multiple system atrophy
progressive supranuclear palsy
huntington’s disease - gradually progressive chorea and behavioural symptoms are earliest.
Is PD familial
Yes
having a first degree relative puts u at 2-3 times increased risk
Other Drug Rx in PD
Rotigotine patch - Levodopa patch in Px with difficulty swallowing, conversion chart for dosage.
Levodopa and dopamine in combination is used in younger Px before
Role of antiemetics in PD
sometimes used to control Sx of N/V+D
problem with them is they can cause parkinsonism - domperidone and stemetil are very bad.
Cyclizine isnt so bad
What are the features of bradykinesia
Difficulty initiating movement Mask Face Shufling gait speech slow and of low volume scribbled Handwriting
What tricks can be used to asses Rx effectiveness
Handwriting before and after Rx
if no improvement cause of parkinsonism should be reassessed
What are the features of Tone in PD
lead-pipe and cog-wheeling
Ask to tap with other hand and asses tone on non-tapng hand
