Parkinson's disease Flashcards
What are symptoms of hyperkinetic movement disorders?
Dystonia Tics Myoclonus Chorea Tremor
What are the cardinal motor symptoms of PD?
Resting tremor
Slowness of movement
Stiffness/ rigidity - bradykinesia
What is the basic pathogenesis of PD?
Reduction of dopaminergic neurones in the pars compacta region of substantia nigra of the basal ganglia
Lewy bodies with alpha synuclein
What non-motor symptoms are assoc with PD?
Sleep disorders; REM behavioural disorder Hallucinations GI disturbances; constipation Bladder problems Pain Depression Cognitive impairment Dementia Anosmia
Does parkinson’s just affect the basal ganglia?
No - lewy bodies can be seen across the whole cortex
What are the 2 subtypes of PD?
Tremor dominant with relative absence of other motor symptoms
Non-tremor dominant such as akinetic rigid syndrome and postural instability gait disorder
Mixed phenotype
Which subtype of PD has a better prognosis?
Tremor dominant; slower rate of progression and less functional disability
What is the diagnostic criteria for PD?
Bradykinesia with one or more of:
Resting tremor of 4-6 Hz
Rigidity; cog wheel or lead pipe
Postural instability not cause by primary visual, vestibular or cerebellar pathologies
What are some additional motor symptoms of PD that are not included in the diagnostic criteria?
Stooped, fixed posture Dystonic posture Hypomimia Shuffling gait Short stepped gait
What 3 things are required for a confirmation of PD?
Parkinsonism features
No alternative explanation
Dopamine responsiveness
What would make you think that a diagnosis of PD is LESS likely?
Early onset bulbar issues
Dementia and hallucinations
Preferential involvement of lower limbs
Prominent eye movement disorder; problems with vertical gaze suggesting supranuclear gaze palsy
Intrusive early autonomic problems; presyncope, bladder incontinence, gastroparesis
What are risk factors for PD?
Advancing age Positive family history with early onset below 40yrs Male gender Environmental factors Genetics
Which environmental factors increase the risk of developing PD?
Pesticide exposure Prior head injury Rural living Beta-blocker use Agricultural occupation Well water drinking
Which environmental factors will decrease the risk of developing PD?
Smoking Coffee drinking NSAID use CCB use Alcohol consumption
Which gene is associated with autosomal dominant PD?
LRK2
