Parkinson's disease

Question 1

pathophysiology of Parkinson’s disease

Answer 1

• Destruction of dopaminergic neurones in pars compacta
  of substantia nigra.
• β-amyloid plaques
• Neurofibrillary tangles: hyperphosphorlated tau

Question 2

general symptoms/signs of Parkinson’s disease

Answer 2

TRAPPS PD
Tremor
Rigidity
Akinesia
Postural instability
Postural hypotension
Sleep disorders
Psychosis
Depression/Dementia/Drug side effects

Question 3

features of Parkinson’s Disease tremor

Answer 3

↑ by stress, ↓ by sleep

Question 4

features of Parkinson’s Disease rigidity

Answer 4

lead-pipe

cog-wheel

Question 5

features of Parkinson’s Disease akinesia

Answer 5

slow initiation, 
difficulty with repetitive movement,
micrographia, 
monotonous voice, 
mask-like face

Question 6

features of Parkinson’s Disease postural instability

Answer 6

stooped gait with festination

Question 7

features of Parkinson’s Disease postural hypotension

Answer 7

+ other autonomic dysfunction

Question 8

features of Parkinson’s Disease sleep disorders

Answer 8

affects 90% of PD pts.
insomnia
excessive daytime sleepiness (due to insomnia +frequent waking)
obstructive sleep apnoea
REM sleep behaviour disorder (loss of muscle atonia during REM sleep, violent enactment of dreams)

Question 9

features of Parkinson’s Disease psychosis

Answer 9

visual hallucinations

Question 10

features of Parkinson’s Disease autonomic dysfunction

Answer 10

• Combined effects of drugs and neurodegeneration
• Postural hypotension
• Constipation
• Hypersalivation → dribbling (↓ ability to swallow saliva)
• Urgency, frequency, Nocturia
• Erectile dysfunction
• Hyperhidrosis

Question 11

acronym for side effects of L-DOPA

Answer 11

DOPAMINE

• Dyskinesia
• On-Off phenomena = Motor fluctuations
• Psychosis
• ABP↓
• Mouth dryness
• Insomnia
• N/V
• EDS (excessive daytime sleepiness)

Question 12

investigations for Parkinson’s disease

Answer 12

DaTSCAN

Question 13

general management of Parkinson’s disease

Answer 13

• MDT: neurologist, PD nurse, physio, OT, social worker,
  GP and carers
• Assess disability
• e.g. UPDRS: Unified Parkinson’s Disease Rating Scale
• Physiotherapy: postural exercises
• Depression screening

Question 14

medical management of Parkinson’s disease in young onset + biologically fit

Answer 14

1. Da agonists: ropinirole, pramipexole
2. MAO-B inhibitors: rasagiline, selegiline
3. L-DOPA: co-careldopa or co-beneldopa

Question 15

medical management of Parkinson’s disease in biologically frail + comorbidities

Answer 15

1. L-DOPA

2. MOA-B inhibitors

Question 16

other drug therapies for Parkinson’s disease

Answer 16

• COMT inhibitor: tolcapone, entacapone
• Lessen end-of-dose effect
• Apomorphine: potent Da agonist
• SC rescue pen for sudden “off” freezing
• Amantidine: weak Da agonist
• Rx of drug-induced dyskinesias
• Atypical antipsychotics: e.g. quetiapine
• Disease-induced psychosis
• SSRIs: citalopram, sertraline
• Depression

Question 17

surgical management of Parkinson’s disease

Answer 17

• interrupt basal ganglia

- deep brain stimulation