Parkinsons Flashcards
What are 3 common symptoms of Parkinsons’s?
Tremor
Rigidity
Bradykinesia/hypokinesia
What are 5 non-motor features of Parkinson’s?
Sense of smell reduced
Constipation
Visual hallucinations
Frequency/urgency
Dribbling
Depression & dementia
What are 4 types of Parkinson’s plus syndrome?
Progressive supranuclear palsy
Multiple system Atrophy
Cortico-basal degeneration
Lewy body dementia
Define LBD.
Demenetia with lewy bodies & Parkinson’s disease dementia
What do the symptoms of LBD depend on?
Speed of development of cognitive difficulties/hallucinations in relation to movement issues
What brain regions do lewy bodies affect?
7 regions including hippocampus & limbic system
What are the 5 main symptoms of LBD?
problems with memory
attention
inability to understand visual info
planning
multitasking
What are 3 emotional signs of LBD?
Low mood
Loss of initiative
confusion
Where are lewy bodies located in dementia with lewy bodies?
Cerebral cortex
Where are lewy bodies located in Parkinson’s disease?
Substantia nigra
Where are lewy bodies located in Parkinson’s disease dementia?
cerebral cortex & substantia nigra
What type of neurodegenerative disorder is PD?
Polygenic - change in conformation of protein into deposits
What do lewy bodies accumulate from?
Alpha synuclein
What type of neurons are lost in PD?
nigrostriatal Dopaminergic neurons
What do the loss of dopaminergic neurons cause?
More tonic inhibiton of VA/VL complex of thalamus by basal ganglia -> decreased excitation of frontal cortex
What inhibitory cells are increased in PD?
Inhibitory cells in substantia nigra pars reticulata
What 4 loops are affected in PD?
Motor
Oculomotor
Prefrontal
Limbic
What could the disruption of non-motor loops cause?
Deterioration of cognitive & emotional function in PD
When do symptoms start to present?
When 50-60%% of dopaminergic neurons are lost
What 2 types of tegmental dopaminergic neurons does PD affect?
Dopamine transporter (DAT)
Tyrosine hydroxylase (TH)
What is the main treatment of PD?
Increase DA transmission pharmological using dopamine precursors or dopamine agonists
What is a DA precursor?
Levodopa
What are 4 DA agonists?
Bromocriptine
Pramipexole
Rotigotine
Ropinrole
How is L-DOPA different to DA?
L-DOPA can cross BBB
What does L-DOPA prevent?
prevents freezing and tremors
Why are dopamine agonists use?
To delay start of L-DOPA treatment as many S/Es come with L-DOPA
What is a third treatment?
MAO-B inhibitors
What does MAO-B do?
Degrades dopamine
What are 2 types of MAO-B inhibitors?
Selegline
Rasagline
What are COMT used for?
Lessens ‘off’ time in those with end-of-dose wearing off
What are anticholinergics used for?
Efficient for tremors
What id duodopa?
Combination of levodopa & carbidopa in a gel for continuous intestinal administration
What 4 brain disorders does deep brain stimulation treat (DBS)?
PD
Epilepsy
Stroke
Severe OCD
What are 4 characteristics of DBS?
Impanation can be unilateral or bilateral
Customized individually
continuous
immediate reduction in tremors
What are 4 negatives of DBS?
Time consuming surgery
difficulty programming
difficulty with electrode targeting
heterogeneity of neuronal tissue affected
What does DBS interrupt?
Abnormal information flow via functional disconnection of stimulated neuronal structures
