Parkinsonism and Movement Disorders Flashcards
Describe the different movements in hypokinetic and hyperkinetic disorders
Hypokinetic - bradykinesia, muscle rigidity
Hyperkinetic - tremors, dystonia, chorea, tics
How do the direct and indirect pathways involved in dopamine release signal differently?
Direct pathway = from cortex to globus pallidus internus
Indirect pathway = from cortex to globus pallidus externus
What is the most common neurodegenerative disease?
Alzheimers
Parkinson’s disease can also cause non-motor symptoms which impair patients quality of life. TRUE/FALSE?
TRUE
What percentage of dopaminergic neurones have already been lost in parkinsons disease by the time motor symptoms appear?
60-80%
Describe the pathological and histological signs of parkinsons disease.
Pathology = loss of substantia nigra in midbrain Histology = lewy bodies present
What motor symptoms are most commonly associated with parkinsons disease?
Bradykinesia
Resting Tremor
Rigidity
Postural instability
What non-motor symptoms can be associated with parkinsons?
Anosmia constipation and early satiety RBD (sleep disorders) Mood changes Cognitive changes
What questions should you ask to determine if a patient with suspected parkinsons has an RBD sleep disorder?
Ask bed partner of patient if pt is
- acting out their dreams
- injuring themselves/bed partner
- Pt doesnt feel well rested in morning
Motor symptoms associated with parkinsons are often assymetrical. TRUE/FALSE?
TRUE
Pt notices one side is worse than the other
What is “festination of gait” in relation to parkinsons?
Pt runs forward to catch their centre of gravity
What type of posture and gait would make you suspective of parkinsons disease?
Stooped posture
Arm swing or held up in flexed position
Shuffling/short-stepping gait
Smaller steps to turn on the spot
What additional signs would make you consider a pathology other than parkinsons?
- not responding to dopamine agonists
- supranuclear palsy (struggle in vertical gaze)
- intrusive early autonomic problems
- *think Parkinsons PLUS disorders**
What is a DaTSCAN used to visualise?
Dopaminergic neurons in the substantia nigra
What environmental risk factors can contribute to the development of parkinsons disease?
Pesticide exposure
Head injury
Agricultural occupation
What genetic mutations have been linked to the development of parkinsons disease?
Autosomal Dominant
- Alpha-synuclein (SNCA)
- LRRK2
Autosomal Recessive
- Parkin
What two brands of Levodopa are currently available in the UK?
MADOPAR
SINEMET
Tremors are always responsive to levodopa therapy. TRUE/FALSE?
FALSE
Tremors are inconsistently responsive to dopamine agonists => some patients require additional drugs to control these
Why are MAO-inhibitors sometimes used in parkinsons disease?
These drugs prevent the breakdown of dopamine
What are the potential short and long term side effects of dopamine agonist drugs?
SHORT TERM:
Nausea
Daytime somnolence
oedema
LONG TERM:
- motor fluctuation
- dyskinesia
- drug induced psychosis
Why is pramipexole usually given instead of traditional dopamine agonist therapy?
It is also a mood booster => if pt is lso experienceing low mood symptoms, then this can counter both symptoms
What questions should you ask a patient who you suspect has parkinsons disease to gather a specific history?
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?
What different types of tremor exist?
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)
