Parkinson's disease Flashcards by Ria Marwaha

what is the mean age for Parkinson’s disease

65 years old

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what is Parkinson’s disease

neurodegenerative condition caused by degeneration of dopaminergic neurones in the substantia nigra

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what is the classic triad of symptoms in Parkinson’s disease

bradykinesia
resting, pill rolling tremor
cogwheel rigidity

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name 3 psychiatric features of Parkinson’s disease

psychosis
dementia
depression

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what are the facial, voice and hand writing changes that can occur in Parkinson’s disease

mask like facial expression
micrographia
hypophonia

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why does blood pressure need to be monitored in Parkinson’s disease?

postural hypotension can develop

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describe a Parkinsonian gait

stooped posture
difficulty initiating movement + turning
small shuffling steps
reduced arm swing
freezing is common

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name a differential diagnosis of Parkinson’s disease

Essential tremor

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inheritance pattern of Essential tremor

autosomal dominant

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type of tremor in Essential tremor?

postural tremor, that usually affects both sides

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what is the tremor in essential tremor made better and worse by?

better by: alcohol + rest

worse by: movement such as eating and drinking

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how is Essential tremor managed

Propranolol is 1st line, Primidone

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Pathophysiology of Idiopathic Parkinson’s disease?

Neurodegeneration of the pre-synaptic neurones in the substantia nigra, loss of dopamine delivery to the basal ganglia

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what is the triad of Dementia w/ Lewy bodies

Parkinsonism, Dementia, Visual hallucinations

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management of vascular dementia?

50% respond to Levadopa

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management of Dementia w/ lewy bodies?

shared care bwtween;

psychiatry
neurology
geriatrics

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name 4 medications that can cause drug induced Parkinson’s disease

prochloroperazine
haloperidol
metoclopramide
cyclizine

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name conditions that have symmetrical Parkinsonism

Drug induced Parkinsonism
Multiple system atrophy
Progressive supranuclear palsy

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name 2 Parkinsonian plus syndromes

Progressive supranuclear palsy
+
Multi-system atrophy

What is multi-system atrophy characterised by?

autonomic features + cerebellar signs

autonomic features in multisystem atrophy?

erectile dysfunction
balance + breathing problems
atonic bladder

management of Mutli-system atrophy?

Levadopa + supportive treatment

what is progressive supranuclear palsy characterised by?

gradual deterioration of brain cells in areas of the brain including the substantia nigra

clinical features of progressive supranuclear palsy? (3)

1) early falls
2) speech slurring
3) vertical gaze impairment

normal pressure hydrocephalus is due to ___

build up of CSF in the ventricles

triad of normal pressure hydrocephalus?

- dementia - gait disorder - bladder instability

what is cortico-basal degeneration due to?

abnormal tau cells accumulate in certain areas of the brain e.g. basal ganglia and eventually cause deterioration

management of normal pressure hydrocephalus?

diagnostic LP --> CSF removal --> insert VP shunt

medication to give to a patient is the motor symptoms are affecting their QoL?

levadopa

what is Ropinirole?

oral agent: dopamine receptor agonist

safe anti-sickness medication to give in Parkinson's disease?

Domperidone

adverse effects of dopamine receptor agonists

- excessive sleepiness - hallucinations - impulse control disorders

Rasagaline + Selegiline are part of what group of medications?

MAO-B | - Inhibit the breakdown of dopamine secreted by dopaminergic neurones

what is the duration of effectiveness of Levadopa?

2 years

name 4 side effects of Levadopa

- dry mouth - postural hypotension - palpitations - drowsiness

Enatcapone is a ___ inhibitor

COMT inhibitor

type of medication used to treat drug induced Parkinsonism

anticholinergics

non - medical management of PD?

- physiotherapy - occupational therapy - speech + language therapists (inc. swallowing)

how to explain to a patient how Levadopa works?

your body converts levadopa into dopamine. it already occurs naturally in our bodies, and taking it as a drug treatment boosts the supply, meaning nerve cells can make more dopamine

what is controlled release Levadopa and what are the benefits of it?

Allow Levadopa to enter your body slowly instead of all at once. particularly helpful if they are taken before going to bed to reduce stiffness during the night

what are dispersible Levadopa tablets?

can be mixed with water to make a drink, takes effect more quickly than capsules, can be used if you have difficulty swallowing tablets or capsules.

What is Duodopa?

intestinal gel; reduce involuntary movements side effects and drug wearing off

when to take Levadopa in relation to eating?

30-60 minutes prior to eating

what type of food can cause patients taking Levadopa to feel nauseous or interfere with the absorption>

protein | found in; meat, eggs, fish, cheese

common side effects of Levadopa?

- nausea + vomiting - hypotension - apetite loss - sleep problems

adverse effects of Levadopa?

- dyskinesia (with long term use) | - impulsive and compulsive behaviour