Parkinson's Disease Lecture Powerpoint Flashcards
Parkinsonism vs parkinson disease (what is a defining characteristic that makes parkinson’s disease stand out)
Parkinsonism is the clinical syndrome presenting with any combo of bradykinesia, rest tremor, rigidity, and postural instability with the most common cause being parkinson’s disease but there are many others, vs parkinson’s disease is a chronic progressive disorder caused by degenerative loss of dopaminergic neurons in the brain characterized clinically by aysmmetric parkinsonism (defining trait) and a clear dramatic benefit from dopaminergic therapy
TRAP acronym for parkinsonism
rest Tremor
Rigidity
brady or Akinesia
Postural instability
Differential diagnosis of parkinsonism (4)
- Parkinson disease (most common)
- Dementia with lewy bodies
- Multiple system atrophy
- Huntington disease
Dementia with Lewy bodies
-Second most common form of degenerative dementia characterized by early psychotic symptoms (unlike parkinsons which that is late stage), see fluctuations in attention or level of arousal and protein aggregate buildups called lewy bodies in neurons and REM sleep disorder behavior disorder (act out dreams)
Multiple system atrophy (what is its one unique characteristic)
A slightly more common parkinsonism disease in men than women that causes autonomic dysfunction, cerebellar signs, and parkinsonism that is poorly responsive to levodopa therapy with a median survival rate of 6-9 years but is always bilateral (not asymmetric), lacks rest tremor or cortical sensory loss.
-Characteristic finding is stimulus sensitive myoclonic jerk
3 subtypes of multiple system atrophy
Shy drager syndrome, striatonigral degeneration, olivapontocerebellar atrophy
Multiple system atrophy treatment (1)
-palliative symptomatic treatment
Progressive supranuclear palsy
A rare form of parkinsonism characterized by early instability with falls, failure to respond to levodopa therapy, and marked slowing of vertical gaze (especially downward) with a median survival rate of 5-9 years but is always bilateral, lacks rest tremor or cortical sensory loss
Corticol basal degeneration
Form of parkinsonism with insidious onset and progression of ASYMMETRIC cortical and basal ganglionic features, speech impairment, cortical dysfunction, and abnormal slow horizontal saccades (slow moving compared to nystagmus)
Essential tremor
Most common neurologic of an action tremor that usually affects hands and arms but also head, chin, trunk, and legs. Not commonly isolated tremor, and often becomes readily apparent when arms arms outstretched or engaged in activities such as writing
Depression and Parkinsonism
Often may see overlap in symptoms such as flat affect, bradykinesia, decreased appetite making it hard to differentiate source
Idiopathic and familial basal ganglia calcification/fahr disease
A type of parkinsonism that is due to accumulation of calcium in the basal ganglia (but not other parts of body) that then results in early age onset (as early as 20) parkinsonism
Common causes of secondary parkinsonism (7)
- Antipsychotropic agents (can take a while to develop effects, remit after cessation)
- toxins (cyanide poisoning can mimick)
- head trauma
- lesions
- metabolic disorders
- infection (toxoplasmosis in cat poop)
- CVD
Pseudohypoparathyroidism
A secondary cause of parkinsonism from high parathyroid hormones but low blood Ca2+ due to resistance in response of the body in the pathway to increase levels
Vascular parkinsonism
A type of parkinsonism caused by its primary risk factor CVD, do NOT see rest tremor but do see prominent instability and gait disorder