Parkinson's Disease Flashcards
What is the triad of parkinsonism?
rigidity
bradykinesia
resting tremor
What is ballismus?
increased amplitude chorea
What is chorea?
fragments of movements flow irregularly from one body segment to another causing a dance-like appearance
What structures make up the basal ganglia?
caudate nucleus putamen globus pallidus sub thalamic nucleus substantia nigra
What are the 2 broad subtypes of Parkinson’s?
Tremor dominant
non-tremor dominant
Which subtype of parkinsons has a better prognosis?
tremor-dominant
Which symptoms tend to come first, motor or non-motor?
non-motor
What are some examples of non-motor features?
olfactory dysfunction cognitive impairment psychiatric symptoms sleep disorders autonomic dysfunction pain and fatigue
How is rapid eye movement sleep behaviour disorder treated?
clonazepam/melatonin at bedtime
What is the pathological hallmark of parkinson’s disease?
loss of dopaminergic neurones in the substantia nigra
What protein forms Lewy Bodies?
alpha-synuclein
what is the greatest risk factor for PD?
Age
Is there a genetic component to PD?
Yes
Which drug cures parkinsons disease?
No cure!!
Which drugs can be effective in treating tremor?
anticholinergic agents
trihexyphenidyl
clozapine
What adverse effect are associated with dopamine agonists and levadopa?
nausea
daytime somnolence
oedema
psychosis
What is an example of a dopamine agonist?
bromocriptine
What is the difference between dopamine agonists and levadopa?
levodopa is converted into dopamine in the brain, dopamine agonists mimic the effect of dopamine without needing to be converted
Which patients should not receive dopamine agonists?
gamblers, binge eating, compulsive spenders
elderly with cognitive impairment
addition/OCD
At what point during treatment do dyskinesias tend to occur?
maximum dose of levodopa
Can dopaminergic therapies cause psychosis?
yes - drug induced psychosis
What drugs are used to manage PD psychosis?
clozapine
quetiapine
What is rivastigmine?
cholinesterase inhibitor
helps reduce visual hallucinations and delusions in PD patients
what surgical treatments are available for PD?
deep brain stimulation of the sub thalamic nucleus or globus pallidus internus
What is bradykinesia?
slowness of movement with progressive loss of amplitude/speed
What movements assess bradykinesia?
opening and closing hand
foot tapping
What other motor symptoms are seen in PD?
hypomimia
hypophonia
micrographia
What kind of tremor is seen in PD?
resting tremor
commonly “pill-rolling”
What features are seen in Parkinsonian gate?
stooped posture slow, shuffling decreased arm swing slow turning with many steps freezing festination
What are common premotor symptoms?
sleep disorder
loss of smell
constipation
Parkinson’s disease is typically symmetrical - T/F?
False
What is a DAT scan?
dopamine transporter imaging to assess dopaminergic function
What will be seen on a DAT scan in a patient with essential tremor?
nothing
What is drug induced parkinsonism?
emergence of parkinsonism after specific drug treatment
What are distinguishing features of essential tremor?
autosomal dominant inheritance
responsive to alcohol
what features are seen in multi-system atrophy?
dysautonomia
cerebellar features
parkinsonism
What is progressive supra nuclear palsy?
symmetrical akinetic rigid syndrome with predominantly axial involvement
which facial muscle is continuously activated in patients with PSP?
frontalis
