Parkinsons

Question 1

What is Parkinson’s?

Answer 1

It is a progressive neurodegenerative disorder resulting mainly from loss of dopamine in the substantial nigra.

Question 2

What is Parkinsons a result of?

Answer 2

degeneration of dopaminergic neurons

Question 3

Aetiology of Parkinsons?

Answer 3

Damage occurs in the nigrostriatial pathway, which ascends from the substantial nigra to corpus striatum

Reduction in inhibitory effects of the dopaminergic pathway on the extrapyramidal motor system

Exaggeration of excitatory effect of acetylcholine pathway

Loss of GABAergic, non-adrenergic and serotonergic neurones

Question 4

symptoms of Parkinson’s?

Answer 4

tremor in upper extremity at rest
bradykinesia
rigidity
gait difficulty
dystonia
postural instability
laryngeal dysfunction and dysphagia
autonomic dysfunction and cardiopulmonary impairment
depression and dementia

Question 5

How are resting tremors tested?

Answer 5

1st test- relax arms on the legs while in seated position and count aloud backwards from 10

2nd test- arm is observed in an outstretched position to assess postural tremor.

Question 6

how is bradykinesia diagnosed?

Answer 6

Through observation of the patients blinking rate and facial expression, speed and amplitude of movements.

Question 7

What are the two types of rigidity?

Answer 7

lead pipe and cogwheel

Question 8

Describe lead pipe rigidity?

Answer 8

when trying to bend it feels stiff, like bending a lead pipe, or moves in small rapid jerks because the muscle group controlling the movement are not properly coordinated.

Question 9

How is ridgity tested?

Answer 9

By flexing and extending the patients relaxed wrist. It is made more obvious with voluntary movement in the contralateral limb and resistance to passive movement in a joint.

Question 10

What is dystonia?

Answer 10

cramping or aching and a tendency of the extremity (usually the foot) to turn in or the great toe to dorsiflex, curling, inversion to plantar flexion of the foot.

Question 11

What is postural instability?

Answer 11

refers to imbalance and losss of righting reflexes,

Question 12

What is laryngeal dysfunction and dysphagia?

Answer 12

people without PD can sustain vowel phonation for a maximum duration, counting to 50 and reading a passage that tests articulation.

Question 13

how is laryngeal dysfunction and dysphagia diagnosed?

Answer 13

listen closely for reduced or diminishing loudness and intonation and increasing breathiness and hoarseness, a soft monotone voice, vocal tremor, poor articulation, variable speech rate, trouble with the initiation of speech.

Question 14

what disease should PD patients be also screened for?

Answer 14

Depression

Question 15

What do autonomic dysfunction and cardiopulmonary impairment present as in patients with PD

Answer 15

Orthostatic hypotension

impaired intestinal motility- which can lead to constipation, vomiting and impaired absorption

Erectile dysfunction + episodes of sweating

Question 16

What should be given to treat Rapid eye movement sleep behaviour disorder?

Answer 16

Clonazepam
melatonin

Question 17

First line treatment for PD?

Answer 17

Levodopa- usually given with a dopa decarboxylase inhibitor e.g. co-beneldopa or co-careldopa

Question 18

Examples of oral monoamine oxidase-B inhibitors?

Answer 18

Selegiline, rasagiline or safinamide

Question 19

What are the consumption benefits of MAO-B inhibitors?

Answer 19

they do not cause an interaction after consumption of tyramine Rich foods.

Question 20

Examples of oral dopamine agonists

Answer 20

rotigotine