Parkinson's Disease Flashcards
What is Parkinson’s disease?
Neurodegenerative disease that arises due to dopaminergic neurone loss in the brain
Which part of the brain does dopaminergic loss occur in Parkinson’s disease?
Substantia nigra pars compacta
Is Parkinson’s disease typically a cerebellar, pyramidal tract or extra-pyramidal tract problem?
Extra-pyramidal
List the triad of the “Parkinsonian syndrome”
Rigidity
Bradykinesia
Resting tremor
List clinical motor features of Parkinson’s disease
Resting tremor Muscle rigidity +/- cogwheeling Bradykinesia Gait Postural impairment
Tremor-dependent Parkinson’s disease carries better prognosis than tremor-independent Parkinson’s disease. True/False?
True
List clinical non-motor features of Parkinson’s disease
Olfactory dysfunction Cognitive impairment Psychiatric symptoms - hallucinations GI dysfunction Depression Sleep problems Pain and fatigue
Diagnosis of Parkinson’s disease occurs with the onset of motor symptoms. True/False?
True
What is the pathological name given to the mis-folded protein aggregates that accumulate in the brain to cause Parkinson’s disease?
Lewy bodies and neurites
Parkinson’s disease is the most common neurodegenerative disease. True/False?
False
2nd most common after Alzheimer’s disease
Which gene mutations are the most common causes of dominant and recessive Parkinson’s disease respectfully?
LRRK2 (dominant)
Parkin (recessive)
There are no neuroprotective/disease-modifying drugs for Parkinson’s disease. True/False?
True
List some drugs that can be used for symptomatic treatment of Parkinson’s?
LEVODOPA Dopamine agonists e.g. Selegelline Monoamine oxydase type B inhibitors Amantodine Tolcapone
Which agents can be useful for tremor in Parkinson’s disease?
Clozapine
Anticholinergics
List side effects of levodopa and dopamine agonists
Nausea
Daytime somnolence
Oedema
When do motor features appear during the coarse of Parkinson’s?
In late Parkinson’s Disease
After 60-80% of dopamine cells are dead
Which sign on imaging would suggest a diagnosis of Parkinson’s Disease?
Dark black pigment loss (loss of substantia niagra)
What is the action of drugs used in Parkinson’s Disease?
Increase dopamine concn or stimulate dopamine receptors.
Parkinson’s is a selective neurogenic disease. True/ False?
False
Variety of neurotransmitters affected, including dopamine, noradrenaline, acetylcholine, serotonin
What is typically the first clinical sign to appear in Parkinson’s Disease?
Non-motor sign: GI dysfunction
What are the main subtypes of Parkinson’s Disease?
Tremor dominant (absence of other motor symptoms) Non-tremor dominant (akinetic rigidity + postural instability) Mixed/ indeterminate
Which diagnostic tests may be helpful in Parkinson’s disease?
Structural brain imaging (view basal ganglia)
SPECT (DaTSCAN)
Which symptoms in a patient would make a diagnosis of Parkinson’s Disease less likely?
Early onset bulbar problems
Early dementia and hallucinations
Eye movement disorder
Intrusive early autonomic problems
What is classed as ‘Parkinsonism’?
Bradykinesia and 1 of following:
Resting tremor
Rigidity (cog-wheel or lead pipe)
Postural instability
List the risk factors of Parkinson’s Disease
Increasing age Family history Male Environmental factors Genetics
Drugs used to manage Parkinson’s disease are associated with what long term complications?
Motor fluctuations
Non-motor fluctuations
Dyskinesia (levodopa)
Drug induced psychosis (e.g. dopamine agonists- impulse control disorders, hallucinations)
List some non-pharmacological therapies that can be used in Parkinson’s Disease?
Deep brain stimulation
DUODOPA
Continuous apomorphine infusion
A tremor in which anatomical location is particularly suggestive of Parkinson’s Disease?
Chin
How would you go about eliciting a resting tremor in Parkinson’s?
Ask the patient to count backwards from 100
Which subset of Parkinson’s involves degeneration of midbrain and vertical gaze palsy?
Progressive supranuclear palsy
Which subset of Parkinson’s involves orthostatic hypotension and a poor response to levodopa?
Multiple system atrophy
Which drug should be used to control vomiting in Parkinson’s?
Domperidone - dopamine agonist that doesn’t cross the BBB
Which medication should be used for a patient on Parkinson’s therapy with acute psychosis?
Quetiapine
