Parkinson's Disease and Parkinsonism 2 Flashcards
What 3 symptoms make up the Parkinsonism syndrome?
Rigidity
Akinesia/Bradykinesia
Resting tremor
What is chorea? What is ballismus?
Fragments of movement flowing irregularly through the body = dance like
Ballismus = if amplitude large.
What is protective for Parkinson’s disease?
Robust association between smoking and PD protection.
Pathological changes in Parkinson’s disease?
Degeneration of dopaminergic neurones within the substantia nigra.
Accumulation of Lewy Bodies within substantia nigra, loss of pigment in substantia nigra correlates with dopamine loss.
Loss of normally black pigment in substantia nigra and locus coeruleus.
Do you get a head tremor in PD?
Head tremor is NOT typical for Parkinson’s diseas.e
What is a positive Froment’s manoeuvre?
Rigidity increases in examined body part by voluntary movement of other body parts.
What are the features of a Parkinson’s exam?
1) General inspection of facial expression and resting tremor.
2) Gait; assess walk and ability to turn.
3) Upper limb: tone, reflexes and finger-thumb tap
4) Lower limb: tone and reflexes.
5) Head and face;
- eye movements (vertical palsy and nystagmus)
- speech; take history to assess speech
- Glabella tap: should stop blinking upon tapping forehead but in Parkinson’s blinking will continue.
- Writing, ask them to write a sentence to look for decrease in size of handwriting.
Initial management of Parkinson’s?
50mg levodopa QDS, do not exceed 600mg/day.
What drug is used a rescue medication for sudden off states in patients using levodopa?
Apomorphine.
What drug is used for nausea in Parkinson’s?
Domperidone; used to treat levodopa associated nausea.
This is used as it does not cross the BBB, so won’t prevent the activity of levodopa in the brain.
AVOID metoclopramide.
Vascular Parkinsonism?
Parkinsonism that affects predominantly the lower limbs therefore associated with gait disturbances.
Rest tremor is uncommon.
Step wise progression.
Pyramidal signs often seen.
Drug induced Parkinsonism? What drugs can be responsible and how does it present?
Metoclopramide, antipsychotics, amiodarone.
Parkinsonism tends to be symmetrical, often a coarse postural tremor.
Improvement/resolution within a few months of drug withdrawal.
What is a red flag for Parkinson’s disease?
Lack of assymetry. One side ALWAYs worse than another.
Dementia with Lewy Bodies?
Presents with cognitive decline and visual hallucinations.
Fluctuating levels of attention.
Degeneration of the cortical areas of the brain with formation of cortical Lewy bodies which can be detected by immunochemical staining for the protein ubiquitin.
Cognitive decline occurs first BEFORE the symptoms of parkinsons.
When does multi system atrophy present?
Presents in 6th or 7th decade.
