Parkinson's Disease Flashcards
Give 5 risk factors for Parkinson’s Disease
>60 years old Family history Hx of brain trauma Male Obesity Low vitamin D
Give the 3 main causes of parkinsonism
Idiopathic Parkinson’s Disease
Medication- induced- antipsychotics, metoclopramide, valproate, lithium, amiodarone
Vascular Parkinson’s- series of small strokes can reduce blood flow to the brain and cause Parkinson’s
Parkinson plus syndromes wilson's disease Essential tremor Huntington's disease CJD
What is the pathophysiology of Parkinson’s disease?
Progressive dopaminergic neuron degeneration in the substantia nigra (in basal ganglia). Less dopamine at the receptors of the stratum so transmission to the thalamus and motor cortex is reduced which results in the symptoms of Parkinson’s.
Build up of Lewy bodies in the basal ganglia, cortex and brainstem
What are the 3 core features of Parkinson’s Disease?
Extrapyramidal triad:
Tremor- pill rolling, unilateral
Hypertonia- rigidity, stiff muscles
Bradykinesia- slow movements
Give 5 examples of motor symptoms in Parkinson’s Disease
Stooped posture
Bradykinesia- slow to move, slow to initiate movement
Reduced arm swing
Mask like face
Pill rolling tremor- increases with stress, decreased with voluntary movement
Micrographia
Rigid arms- cogwheel rigidity/lead pipe
Postural instability
Gait: festinant, shuffling, quick and short steps, slow to initiate movement, need multiple steps to turn.
Give 4 psychological symptoms of Parkinson’s disease
Depression
Anxiety
Mild cognitive impairment
Dementia- severe memory problems, behavioural changes
Give 3 examples of autonomic dysfunction in Parkinson’s Disease
Urinary frequency Constipation Postural hypotension Erectile dysfunction Excessive saliva production
How is Parkinson’s Disease diagnosed?
Clinical diagnosis- Need all 3 core features
Levodopa challenge- if symptoms are relieved by Levodopa then highly suggestive of Parkinson’s Disease
Can do Head CT/MRI to rule out other diagnoses
Who is involved in the Parkinson’s Disease MDT?
Specialist Parkinson's Disease nurse GP PT OT SALT Palliative care nurse Support groups DVLA Voluntary section CPN
When is Levodopa given in Parkinson’s Disease?
When symptoms of Parkinson’s Disease interfere with daily living
What kind of drug is levodopa?
Dopamine precursor
Which drug is commonly prescribed alongside Levodopa and why?
Dopa-decarboxylase inhibitor- eg. Carbidopa
Inhibits peripheral breakdown of levodopa so more can enter CNS
Give 4 side effects of Levodopa
Hallucinations Insomnia Psychotic symptoms Hypokinesia Dyskinesia N+V
What is the on-off phenomenon experience with levodopa?
Symptoms will be completely cured when drugs is working but as it wears off the symptoms return. Off periods tend to get longer and occur quicker after taking levodopa over time
What is an akinetic crisis?
Sudden withdrawal of L-DOPA results in complete inability to move and requires ITU treatment
Give 3 examples of Dopamine agonists
Pramipexole, Ropinirole, Rotigotine, Apomorphine, Bromocriptine
Give 4 side effects of dopamine agonists
Risk of heart problems Fatigue Dizziness Nausea Constipation Hypotension Headaches Hallucinations Movement problems
Give an example of a Monoamine oxidase-B inhibitor (MAO-B)
Selegiline
Rasagiline
When is a Monoamine oxidase-B inhibitor used to treat Parkinson’s Disease?
Alternative to Levodopa for treating early Parkinson’s. Often used alongside levodopa when more control is needed.
What is the mechanism of action of Monoamine oxidase-B inhibitors?
Block Monoamine oxidase-B which is an enzyme that breaks down dopamine.
Give 3 side effects of Monoamine oxidase-B inhibitors
Nausea Headache Abdominal pain Postural hypotension Atrial fibrillation Depression
Give an example of a Catechol-O-methyltransferase (COMT) inhibitor
Entacapone
How do Catechol-O-methyltransferase (COMT) inhibitors work?
Stop the breakdown of levodopa so used alongside levodopa to increase its effectivity
Give 3 side effects of Catechol-O-methyltransferase (COMT) inhibitors?
Risk of liver damage Sleeping problems Fainting Headaches Dizziness Hallucinations
What is Apomorphine used for in Parkinson’s Disease management?
Subcutaneous injection/infusions of a DA agonist to reduce ‘off’ spells
What is a Parkinson’s Plus Syndrome?
A group of neurodegenerative diseases which present with Parkinsonism but are not Parkinson’s Disease. Usually have a worse prognosis
What signs may be present which suggest a Parkinson’s Plus Syndrome rather than Parkinson’s Disease?
Poor response to levodopa
Rapid progression of dementia
Early onset of postural instability and falls
Early involvement of autonomic nervous system
What is the pathophysiology of Lewy Body Dementia?
Cerebral atrophy especially of the frontal lobe with deposition of Lewy Bodies in glia cells. The Lewy bodies cause myelin and glial dysfunction and subsequent neuronal degeneration.
What are the clinical features of Lewy body dementia?
Dementia
Extrapyramidal motor symptoms
Visual hallucinations
Paranoia
Frequent falls
Rapid eye movement sleep behaviour disorder
Increased sensitivity to neuroleptic medication
How is Lewy body dementia managed?
Supportive therapy
Physiotherapy
Parkinson’s medications can be effective
What is Multiple System Atrophy?
Rare, adult onset neurodegenerative disease characterised by neuronal degeneration in the substantia nigra and Ley body formation.
Give 4 clinical features of Multiple System Atrophy
Parkinsonism
Cerebellar features- ataxia, tremor, dysarthria
Autonomic dysfunction- incontinence, dysphagia, dizziness
Neuropsychiatric disorders
How is Multiple System Atrophy managed?
Supportive
Will have no response to dopamine
What is Progressive Supranuclear Palsy?
Brain is damages as a result of a buildup of the protein tau. As the tau builds up in the brain, the symptoms get worse.
Give 4 clinical features of Progressive Supranuclear Palsy
Frequent falls Frontal lobe abnormalities- apathy, impaired reasoning, disinhibition Vertical gaze palsy Bradykinesia Dysphagia
What is corticobasal degeneration?
Build up of tau damages the cortex and basal ganglia.
Give 3 clinical features of corticobasal degeneration
Unilateral limb failure
Alien limb phenomenon- do not recognise limb as their own
Dementia
Muscle stiffness
How is corticobasal degeneration managed?
Symptom control
Cognitive stimulation
Physiotherapy
SALT
