Parkinsons Flashcards
What is Parkinsons Disease
Condition where there is progressive reduction of dopamine in the basal gangia of the brain, leading to disorders of movement
Classic triad of PD
Asymmetrical resting tremor, rigidity, bradykinesia
Pathophysiology of PD
Degeneration of the corpus striatum and basal ganglia in nigrostriatal pathway - where dopamine is produced
What is the role of dopamine
Essential for the functioning of basal ganglia, responsible for movements and patterns
Motor symptoms in PD
Cogwheeling, parkinsonian gait, hypomimetic faces, postural instability, difficulty getting going, fine motor problems
Non-motor symptoms in PD
Autonomic involvement such as constipation and ED, olfactory loss, REM behaviour disorder, psychiatric problems
How is the tremor descibed in PD
Frequency of 4-6Hz (4-6 times a second). ‘Pill rolling tremor’.
What exaggerates the resting tremor
Distracting patient with other tasks
What makes the tremor better
Voluntary movement
What is ‘Cogwheel’ rigidity
If you take the hand and passively flex and extend their arm at the elbow, there is a tension in their arm that gives way to movement in small increments like tiny jerks
What is bradykinesia
Movements start to get slower and smaller
What is the Parkinsonian gait
Small steps when walking. ‘Shuffling gait’
What is hypomimia
Reduced facial movements and expressions
What can happen to a patients hand writing
Gets smaller and changes
What are Parkinson’s-plus Syndromes
Progressive supranuclear palsy, multiple system atrophy, cortico-basal degeneration, lewy body dementia
What is multiple system atrophy
Degeneration of basal ganglia and other structures in the brain - leads to Parkinsonism, autonomic dysfunction and cerebellar dysfunction
What is progressive supranuclear palsy
Parkinsonism and a vertical gaze
What is cortico-basal degeneration
Parkinsonism and spontaneous activity by an affected limb or akinetic rigidity
What type of dementia is associated with Parkinson’s
Lewy body demetia
What happens in Lewy body dementia
Parkinsonism, and fluctuations in cognitive impairment, visual hallucinations, delusions, disorders of REM
Diagnosis of PD
Based on clinical symptoms and examination - NICE recommend using specific guidelines
Aims of treatment in PD
Enhance nigrostriatal dopaminergic activity and secondly to inhibit cholinergic activity
What is the first line treatment
Levadopa - dopamine precursor. Given with peripheral decarboxylase inhibitor
Co-formulations of levadopa and PDI
Carbidopa and Benserazide given so form Co-careldopa and co-beneldopa.
Side effects of levadopa coformulations
N+V, dystonia, chorea, athetosis, hallucinations, anxiety, sedation, confusion, dizziness
What difficulties can happen with Levadopa over time
Becomes less effective over time
Medical options for management of PD
COMT inhibitors, dopamine agonists, MAOBI, levadopa
Eg of COMT
Entacapone and Tolcapone
What do COMT inhibitors do
Stop metabolism of dopamine in body and brain
Eg of dopamine receptor agonists
Bromocryptine, pergolide, carbergoline, apomorphine, pramipexole, ropinirole, rotigotine
What do dopamine receptor agonists do
Used as an adjunct and in longer duration than levadopa. Usually used after levadopa
Side effects of dopamine agonists
Pulmonary fibrosis, more psychomimetic
What is Domperidone used for
Reduces N+V effects of levadopa
Side effects of domperidone
Vasodilation, postural hypotension, arrhythmias
Eg of monoamine oxidaase-B inhibitors
Selegiline and Rasagaline
What do MOAB inhibitors do
Block enzyme from breaking down dopamine. Used in combination with levadopa
