Parkinsonism Flashcards
What are the cardinal features of PD?
Postural instability
Bradykinesia
Tremor - high amplitude and low frequency pill rolling
Cogwheel rigidity
What are the different types of PD?
Idiopathic PD Vascular PD Drug-induced PD Lewy body PD Progressive supra nuclear palsy Multi-system atrophy
What are the suggestive features of idiopathic PD?
Unilateral onset
Upper limb predominance
Treatment responsive
Presenting bradykinesia
What are the suggestive features of vascular PD?
lower limb predominance
bilateral onset
presentation with falls and gait problems
What are the suggestive features of drug induced PD?
history of typical or atypical antipsychotic prescribing
What are the suggestive features of lewy body dementia?
prominent cognitive impairment presenting at the same time as parkinsonism or within a few months
prominent hallucinations
fluctuations in level of consciousness
What are the suggestive features of progressive supra nuclear palsy?
eye sign-vertical gaze palsy
cognitive impairment with frontal disinhibition
not responsive to dopaminergic treatment
What are the suggestive features of multi-system atrophy?
Prominent autonomic features-orthostatic hypotension, incontinence, impotence, difficulty regulating body temperature-early in presentation
Cerebellar signs
Not responsive to treatment
What is the characteristic gait and posture of a PD patient?
head held forward
drooping eyelids, open mouth, salivary drooling
tremor of hands
slow shuffling gait, short steps
Describe the TW for parkinson treatment
the TW narrows over time and around the 10-15 year mark the proportion of the day “on” or “off” may begin to exceed the portion of the day where the therapy is effective
What is bradykinesia and how is it detected?
slow movements detected using the finger-thumb test
What is rigidity in parkinson’s?
detected as increased tone on movements
the superimposed tremor causes - cogwheeling
Describe the tremor in PD
resting
high amplitude
low frequency (pill rolling)
may be unmasked by mental arithmetic or moving the contralateral limb
How is postural instability detected?
detected using shoulder-tug test
What are the other additional features of parkinson’s?
micrographia - small writing
abnormal gait - slow to initiate, shuffling, short steps, gets faster with momentum
How is a PD diagnosis made?
- predominantly clinical
- CT brain to look for for signs of generalised cerebral ischaemia in patients with suspected vascular dementia
- SPECT scan
- dopaminergic treatment to establish whether idiopathic PD is present
How is treatment monitored for effectiveness?
an appropriate baseline measurement of physical functioning e.g. lindop score, should be taken before treatment, with follow up to measure objective improvements
Which type of parkinsons is treatment for motor symptoms effective?
Idiopathic parkinsons disease
What are the treatment options in PD?
anticholinergic agents
dopamine agonists
monoamine oxidase B inhibitors (MAOBs)
Why should anticholinergic agents not be used in older patients?
they almost always induce confusion
What is the problem when using dopamine agonists?
useful when commenced early, may result in problems with therapeutic window later on
What is the best treatment for older patients or those with a cognitive impairment?
levodopa with a decarboxylase inhibitor
Cobeneldopa cocareldopa - first line agent
What adjuncts are used in addition to dopaminergic therapy?
Catechol-O-methyl transferase (COMT) inhibitors
Amantidine
Why are COMT inhibitors used?
inhibit the breakdown of levodopa and increase its elimination half-life which helps with end of dose deteriorations
When is amantadine used?
in patients with prominent dyskinesias
Which advanced therapies are used in role of later disease?
direct duodenal infusion therapy (duodena)
apomorphine
deep-brain stimulation
What are the non motor symptoms for idiopathic parkinson’s?
may be made worse by drug therapy
depression constipation dribbling of saliva change in taste and smell urinary incontinence insomnia and sleep disturbance unexplained pain
How are these non motor symptoms identified?
non moter symptoms (NMS)
parkinson disease quality of life questionnaire (PDQ)
some are responsive to dopamine therapy
