Parkinson's disease Flashcards
what is the mean age for Parkinson’s disease
65 years old
what is Parkinson’s disease
neurodegenerative condition caused by degeneration of dopaminergic neurones in the substantia nigra
what is the classic triad of symptoms in Parkinson’s disease
- bradykinesia
- resting, pill rolling tremor
- cogwheel rigidity
name 3 psychiatric features of Parkinson’s disease
- psychosis
- dementia
- depression
what are the facial, voice and hand writing changes that can occur in Parkinson’s disease
- mask like facial expression
- micrographia
- hypophonia
why does blood pressure need to be monitored in Parkinson’s disease?
postural hypotension can develop
describe a Parkinsonian gait
- stooped posture
- difficulty initiating movement + turning
- small shuffling steps
- reduced arm swing
- freezing is common
name a differential diagnosis of Parkinson’s disease
Essential tremor
inheritance pattern of Essential tremor
autosomal dominant
type of tremor in Essential tremor?
postural tremor, that usually affects both sides
what is the tremor in essential tremor made better and worse by?
better by: alcohol + rest
worse by: movement such as eating and drinking
how is Essential tremor managed
Propranolol is 1st line, Primidone
Pathophysiology of Idiopathic Parkinson’s disease?
Neurodegeneration of the pre-synaptic neurones in the substantia nigra, loss of dopamine delivery to the basal ganglia
what is the triad of Dementia w/ Lewy bodies
Parkinsonism, Dementia, Visual hallucinations
management of vascular dementia?
50% respond to Levadopa
management of Dementia w/ lewy bodies?
shared care bwtween;
- psychiatry
- neurology
- geriatrics
name 4 medications that can cause drug induced Parkinson’s disease
- prochloroperazine
- haloperidol
- metoclopramide
- cyclizine
name conditions that have symmetrical Parkinsonism
- Drug induced Parkinsonism
- Multiple system atrophy
- Progressive supranuclear palsy
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
