Parkinson's Disease Flashcards
what is PD?
loss of dopamine in the substantia nigra and locus coeruleus of the basal ganglia
presentation
TRAP mask-like expression micrographia sleep disorders, hallucinations, depression, dementia anosmia Parkinsonian gait
TRAP features
tremor (pin rolling)
rigidity (cogwheel)
akinesia/bradykinesia
postural instability
types of rigidity
lead pipe rigidity
cogwheel rigidity
what is lead pipe rigidity?
sustained resistance to passive movement throughout range of motion (bending a lead pipe)
what is cogwheel rigidity?
jerky resistance to passive movement as muscle tenses and relaxes
spasticity over rigidity
describe a Parkinsonian gait
stooped posture with short, shuffling steps and a decreased arm swing
diagnosis of PD
clinical
DaTSCAN= nuclear medicine presynaptic dopaminergic imaging
risk factors for PD
age
FH
male
environmental triggers (head injury, pesticides)
management of PD
levodopa
carbidopa
COMT inhibitors e.g. entacapone and tolcapone
dopamine agonists e.g. pramipexole, bromocriptine
MO-B inhibitors e.g. selegiline, amantadine
anticholinergics for tremor e.g. diphenhydramine
what is levodopa?
synthetic dopamine that crosses the BBB
why is levodopa prescribed with carbidopa and COMT inhibitors?
prevent breakdown and extend action
cautions in dopamine agonists
beware in addicts
risks pulmonary fibrosis
features of Parkinson’s tremor
asymmetrical worse at rest improves with movement other PD features no change with alcohol
features of benign essential tremor
symmetrical
improves with rest
worse with movement
improves with alcohol
