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Neurology > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

From where does the basal ganglia receive input and where does it send output?

A

Input from cortex

Output to cortex and brainstem

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2
Q

What are the functions of the basal ganglia?

A

Help control motor movement, eye movements, social behaviour, executive function/working memory

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3
Q

What is the mean duration of Parkinson’s disease from diagnosis to death?

A

15 years

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4
Q

Describe the pathogenesis of Parkinson’s disease?

A

Loss of dopaminergic neurones within the substantial nigra with surviving neurons containing lewy bodies.
PD manifests clinically after loss fo ~50% of dopaminergic neurons

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5
Q

What are the possible causes of Lewy body formation?

A 
Oxidative stress
Mitochondrial failure
Excitoxcitiy 
Protein aggregation
Interface with DNA transcription
NO
Inflammation
Apoptosis
Trephine deficiency
Infection
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6
Q

What are the cardinal features of Parkinsonism?

A

Bradykinesia
Muscular rigidity
4-6Hz rest tremor
Postural instability

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7
Q

What is bradykinesia?

A

Slowness in initiation of voluntary movement with progressive reduction in speech and amplitude of repetitive actions

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8
Q

What neuropsychiatric symptoms can occur in PD?

A

Dementia
Depression
Anxiety

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9
Q

What autonomic symptoms can occur in PD?

A 
Constipation
Urinary urgency / nocturia
Erectile dysfunction
Excessive salivation / sweating
Postural hypotension
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10
Q

What sleep symptoms can occur in PD?

A

REM sleep behaviour disorder
Restless legs syndrome
Daytime somnolence

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11
Q

Other than the cardinal signs, neuropsychiatric, autonomic and sleep symptoms, what other symptoms can occur in PD?

A

Reduced olfactory function
Fatigue
Pain and sensory problems

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12
Q

Give examples of disorders with are commonly mistaken for PD?

A 
Benign tremor disorders
Dementia with Lewy bodies
Vascular parkinsonism
Parkinson plus disorders
Drug induced Parkinsonism/tremor
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13
Q

Give examples of Parkinson plus disorders

A

Progressive supra nuclear palsy

Multiple system atrophy

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14
Q

If tremor is present in patients with an uncertain diagnosis of Parkinson’s disease what blood tests can be conducted to rule out other causes?

A

TFTs
Cooper
Caeruloplasmin

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15
Q

CT and MRI will appear normal in Parkinson’s disease but these investigations can be sued to rule out which conditions?

A

Vascular parkinonism

Parkinson plus disorders

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16
Q

What functional imaging technique can be used in the investigation of suspected Parkinson’s disease?

A

DAT SPECT

17
Q

What four classes of drugs can be used to treat Parkinson’s disease?

A

L-DOPA
Dopamine agonists
MAO-B inhibitors
COMT inhibitors

18
Q

Describe the action of L-DOPA

A

Taken up by dopaminergic neurons and decarboxylated to dopamine within presynaptic terminals

19
Q

What drug is prescribed alongside L-DOPA to limit its systemic effects?

A

Dopa decarboxylase

20
Q

What is the half life of L-DOPA?

A

90 mins

21
Q

What dose of L-DOPA is given in Parkinson’s disease?

A

200-1000mg a day

22
Q

What are the adverse effects of L-DOPA?

A 
Nausea
Vomiting
Postural hypotension
Confusion
Hallucinations
23
Q

Patients can develop motor complications after long term (5 years) L-DOPA treatment for Parkinson’s disease. T/F?

A

True

24
Q

Give examples of dopamine agonists which can be used to treat Parkinson’s disease?

A

Ropinirole
Pramipexole
Rotigotine
Apomorphine

25
Q

What are the side effects of dopamine agonists?

A

Dopaminergic effects
SOmnolence
Impulse control disorders
Nightmares

26
Q

What are the advantages and disadvantages of dopamine agonists compared to L-DOPA in the treatment of Parkinson’s disease?

A

Advantages - fewer motor complications, longer half life

Disadvanatges p less efficacious

27
Q

Give examples. of MAO-B inhibitors used in the treatsment of Parkinson’s disease

A

Selegiline

Rasagiline

28
Q

What is the action of MAO-B inhibitors?

A

Prevent there breakdown of dopamine by binding irreversibly to monoamine oxidase

29
Q

What drug can be co-prescribe with L-DOPA in later stage Parkinson’s disease to extend the half life and duration of action of L-DOPA?

A

COMT inhibitors

30
Q

Give examples of COMT inhibitors used int he treatment of Parkinson’s disease?

A

Entacapone

Tolacapone

31
Q

Which enzyme to COMT inhibitors act against?

A

Catechol-o-methyltramnsferase

32
Q

What are the possible side effects of COMT inhibitors?

A

Dopaminergic effects

Diarrhoea

33
Q

What complications/symptoms can occur in advanced Parkinson’s disease?

A

Motor complications of ‘on/off’ fluctuations and L-DOPA induced dyskinesia
Poor balance / falls
Speech and swallowing disturbance
Cognitive impairment (dementia)

34
Q

If pharmacotherapy for Parkinson’s disease is ineffective what other therapy might be used in certain patients?

A

Deep brain stimulation of the sub thalamic nucleus.

Neurology (10 decks)

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