Parkinsonism and Movement Disorders

Question 1

Describe the different movements in hypokinetic and hyperkinetic disorders

Answer 1

Hypokinetic - bradykinesia, muscle rigidity

Hyperkinetic - tremors, dystonia, chorea, tics

Question 2

How do the direct and indirect pathways involved in dopamine release signal differently?

Answer 2

Direct pathway = from cortex to globus pallidus internus

Indirect pathway = from cortex to globus pallidus externus

Question 3

What is the most common neurodegenerative disease?

Answer 3

Alzheimers

Question 4

Parkinson’s disease can also cause non-motor symptoms which impair patients quality of life. TRUE/FALSE?

Answer 4

TRUE

Question 5

What percentage of dopaminergic neurones have already been lost in parkinsons disease by the time motor symptoms appear?

Answer 5

60-80%

Question 6

Describe the pathological and histological signs of parkinsons disease.

Answer 6

Pathology = loss of substantia nigra in midbrain
Histology = lewy bodies present

Question 7

What motor symptoms are most commonly associated with parkinsons disease?

Answer 7

Bradykinesia
Resting Tremor
Rigidity
Postural instability

Question 8

What non-motor symptoms can be associated with parkinsons?

Answer 8

Anosmia
constipation and early satiety
RBD (sleep disorders)
Mood changes
Cognitive changes

Question 9

What questions should you ask to determine if a patient with suspected parkinsons has an RBD sleep disorder?

Answer 9

Ask bed partner of patient if pt is

• acting out their dreams
• injuring themselves/bed partner
• Pt doesnt feel well rested in morning

Question 10

Motor symptoms associated with parkinsons are often assymetrical. TRUE/FALSE?

Answer 10

TRUE

Pt notices one side is worse than the other

Question 11

What is “festination of gait” in relation to parkinsons?

Answer 11

Pt runs forward to catch their centre of gravity

Question 12

What type of posture and gait would make you suspective of parkinsons disease?

Answer 12

Stooped posture
Arm swing or held up in flexed position
Shuffling/short-stepping gait
Smaller steps to turn on the spot

Question 13

What additional signs would make you consider a pathology other than parkinsons?

Answer 13

• not responding to dopamine agonists
• supranuclear palsy (struggle in vertical gaze)
• intrusive early autonomic problems
• *think Parkinsons PLUS disorders**

Question 14

What is a DaTSCAN used to visualise?

Answer 14

Dopaminergic neurons in the substantia nigra

Question 15

What environmental risk factors can contribute to the development of parkinsons disease?

Answer 15

Pesticide exposure
Head injury
Agricultural occupation

Question 16

What genetic mutations have been linked to the development of parkinsons disease?

Answer 16

Autosomal Dominant

• Alpha-synuclein (SNCA)
• LRRK2

Autosomal Recessive
- Parkin

Question 17

What two brands of Levodopa are currently available in the UK?

Answer 17

MADOPAR

SINEMET

Question 18

Tremors are always responsive to levodopa therapy. TRUE/FALSE?

Answer 18

FALSE

Tremors are inconsistently responsive to dopamine agonists => some patients require additional drugs to control these

Question 19

Why are MAO-inhibitors sometimes used in parkinsons disease?

Answer 19

These drugs prevent the breakdown of dopamine

Question 20

What are the potential short and long term side effects of dopamine agonist drugs?

Answer 20

SHORT TERM:
Nausea
Daytime somnolence
oedema

LONG TERM:

• motor fluctuation
• dyskinesia
• drug induced psychosis

Question 21

Why is pramipexole usually given instead of traditional dopamine agonist therapy?

Answer 21

It is also a mood booster => if pt is lso experienceing low mood symptoms, then this can counter both symptoms

Question 22

What questions should you ask a patient who you suspect has parkinsons disease to gather a specific history?

Answer 22

Has your handwriting changed? (Tremor etc)
Has your walking capacity decreased?
Can you still turn over in bed?
Are you getting up during the night to go to the toilet?
Can you still button your shirt and cuffs?

Question 23

What different types of tremor exist?

Answer 23

Physiological (e.g. due to nerves/caffeine)

Rest (present when body part not moving)

Postural (present when hands are outstretched)

Kinetic (present during movement of body part)

Intention (amplitude of tremor gets larger on meeting a target)