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Year 3 > Parkinson's disease (N) > Flashcards

Parkinson's disease (N) Flashcards

1
Q

Define Parkinson’s disease.

A

Degeneration of dopaminergic neurons in basal ganglia, from substantia nigra to striatum

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2
Q

What is the pathophysiology of Parkinson’s disease?

A

Degeneration of dopaminergic neurons from substantia nigra to striatum, due to mitochondrial DNA dysfunction

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3
Q

What demographics is Parkinson’s disease more common in? (2)

A
  • M>F
  • mean age of onset: 65y
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4
Q

What is parkinsonism (Parkinson’s disease)?

A

Triad of resting tremor, hypertonia and bradykinesia + additional clinical features

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5
Q

What are some different causes of parkinsonism?

A
  • drug-induced (typically bilateral)
  • Lewy-Body dementia
  • progressive supranuclear palsy (Steel-Richardson)
  • multisystem atrophy
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6
Q

What are some drug-induced causes of parkinsonism? (2)

A
  • antipsychotics e.g. haloperidol
  • metoclopramide
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7
Q

How do we manage tremor in drug-induced parkinsonism?

A

Procyclidine

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8
Q

What are the symptoms of Lewy-Body dementia (parkinsonism)? (3)

A
  • memory loss
  • visual hallucinations
  • parkinsonism
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9
Q

What are the symptoms of progressive supranuclear palsy (Steel-Richardson)? (5)

A
  • postural instability (falls)
  • impaired vertical gaze AKA vertical gaze palsy (difficulty reading or descending stairs)
  • cognitive impairment
  • parkinsonism
  • poor response to levodopa
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10
Q

What are the symptoms of multisystem atrophy (parkinsonism)?

A

Autonomic features like postural hypotension, incontinence and impotence

Poor response to levodopa

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11
Q

What conditions showing parkinsonism have poor response to levodopa?

A

Progressive supranuclear palsy (Steel-Richardson syndrome) & multisystem atrophy

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12
Q

What is sporadic/idiopathic Parkinson’s disease?

A

Most common, unknown aetiology, may be related to environmental toxins or oxidative stress

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13
Q

What can cause secondary Parkinson’s disease? (6)

A
  • neuroleptic therapy (e.g. for schizophrenia)
  • vascular insults (e.g. in basal ganglia)
  • MPTP toxin from illicit drug contamination
  • repeated head injury
  • manganese or copper toxicity (Wilson’s disease)
  • HIV
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14
Q

What are main clinical features of Parkinson’s disease? (4)

A
  • bradykinesia - slowness of movements, shuffling gait, slow-turning
  • resting tremor
  • rigidity - lead pipe, cogwheel
  • postural instability - imbalance or falling, festination and shuffling gait
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15
Q

Describe the resting tremor in Parkinson’s disease. (4)

A
  • asymmetrical onset
  • improves with voluntary movement
  • typically ‘pill-rolling’ (thumb and index finger)
  • 4-6Hz
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16
Q

Describe the rigidity seen in Parkinson’s disease.

A
  • lead pipe rigidity of muscle tone
  • superimposed tremor –> cogwheel rigidity
  • rigidity enhanced by distraction
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17
Q

Describe gait in Parkinson’s disease. (5)

A
  • shuffling
  • stooped
  • small-stepped
  • reduced arm swing
  • difficulty initiating walking
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18
Q

What are some other symptoms of Parkinson’s disease? (6)

A
  • fatigue
  • constipation
  • depression
  • anxiety
  • insomnia
  • hypomimia (reduced facial expressions)
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19
Q

Why can Parkinson’s disease lead to postural hypotension?

A

Due to autonomic failure

20
Q

What are some risk factors for Parkinson’s disease? (5)

A
  • increasing age
  • Hx familial Parkinson’s disease in younger-onset disease
  • mutation in gene encoding glucocerebrosidase
  • MPTP exposure
  • drug-induced (antipsychotics, metoclopramide)
21
Q

How is a diagnosis of Parkinson’s disease primarily made?

A

Clinical diagnosis - Hx alongside presenting features

Revised Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)

22
Q

What are some investigations that can be done for Parkinson’s disease? (3)

A
  • dopaminergic agent (levodopa) trial - improvement in Sx
  • single photon emission computed tomography (SPECT)
  • dopamine transporter scintigraphy - reduction in striatum and putamen
23
Q

What are some differential diagnoses for Parkinson’s disease? (8)

A
  • essential tremor (asymmetry, bradykinesia and rigidity uncommon)
  • normal pressure hydrocephalus
  • parkinsonism
  • drug-induced parkinsonism
  • Lewy-body dementia
  • progressive supranuclear palsy (Steel-Richardson)
  • multisystem atrophy
  • Alzheimer’s disease with parkinsonism
24
Q

What feature is not common in Parkinson’s disease?

A

Diplopia not common in Parkinson’s disease and may suggest an alternative cause of parkinsonism e.g. progressive supranuclear palsy

25
Q

What is the first step to Parkinson’s disease treatment?

A

Urgent referral to neurology, medications can only be initiated by specialists

26
Q

What is the general first line management for Parkinson’s disease?

A

Levodopa

27
Q

What is first-line for Parkinson’s disease if motor symptoms affect QoL?

A

Levodopa (dopamine)

28
Q

What is the first-line treatment for Parkinson’s disease if motor symptoms do NOT affect QoL? (3)

A
  • dopamine agonist (non-ergot derived –> ropinerole, pramipexole, apomorphine), or
  • levodopa, or
  • monoamine oxidase B (MAO-B inhibitor) e.g. rasagiline
29
Q

Why might dopamine agonists/MAO-B inhibitors be used for Parkinson’s disease when motor Sx are not significant?

A

Fewer motor complications

(But dopamine agonists have more specific adverse events)

30
Q

How do we manage Parkinson’s disease if a patient already on optimal levodopa Rx has continued Sx/developed dyskinesia?

A

Addition of dopamine agonist, MAO-B inhibitor or catechol-O-methyl transferase (COMT) inhibitor as an adjunct

31
Q

What is one of the first common side effects of levodopa? (Parkinson’s disease)

A

‘Wearing off phenomenon’ - Sx towards end of dose and prior to next dose, can be managed by increasing administration frequency

32
Q

What may eventually happen with levodopa treatment?

A

On-off effect –> sometimes works, sometimes does not

33
Q

How can we manage nausea (levodopa side effect) in Parkinson’s disease?

A

Domperidone

34
Q

What are some side effects at peak levodopa dose (Parkinson’s disease)? (3)

A
  • dystonia
  • chorea
  • athetosis (involuntary writhing)
35
Q

What is a side effect of dopamine agonists (Parkinson’s disease)?

A

Impulse disorders e.g. pathological gambling

36
Q

What does it mean that Parkinson’s disease medications are ‘critical medications’?

A

Should not be stopped even on acute admissions to hospital, and must be delivered on time to prevent symptom reoccurrence

37
Q

What can acute withdrawal of levodopa cause?

A

Can precipitate neuroleptic malignant syndrome, treated with dopamine agonists (bromocriptine)

38
Q

What supplement can we give for Parkinson’s disease?

A

Vitamin D

39
Q

What supportive care is there for Parkinson’s disease? (3)

A
  • exercise
  • occupational therapy
  • speech therapy
40
Q

What drugs do we avoid in Parkinson’s disease?

A

Antipsychotics (e.g. haloperidol) - can worsen symptoms

41
Q

What are some complications of Parkinson’s disease?

A
  • dementia
  • constipation
  • depression
  • anxiety
  • psychosis
  • dopamine agonists –> impulse control disorder
  • levodopa-induced dyskinesias
42
Q

Describe the prognosis of Parkinson’s disease.

A

Course is progressive, and no curative agents available

43
Q

What is the difference between Parkinson’s disease dementia (PDD) and Lewy-body dementia?

A

Time of onset - overlapping Sx, PDD diagnosed if patient had Parkinson’s disease diagnosis for >1y –> different Rx (PDD = levodopa, DLB = rivastigmine with levodopa only if severe)

44
Q

What is the triad of normal pressure hydrocephalus?

A

Wacky, wobbly, wet

  • dementia
  • gait ataxia/abnormality (similar to Parkinson’s disease)
  • urinary incontinence
45
Q

What is seen on neuroimaging in normal pressure hydrocephalus?

A

Ventriculomegaly in the absence of/out of proportion to sulcal enlargement

Year 3 (193 decks)

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