Parkinsons Flashcards
What is the pathology of Parkinsons?
degeneration of the substantitia nigra in the basal ganglia and locus cerulus - this shows dominergic cell loss
loss of normally dark black pigment
What is the presentation of Parkinsons?
60-70% of neurodegenerative damage is done before you develop the motor symptoms
motor symptoms: tremor, bradykinesia, rigidity, postural instability
non motor symptoms: sleep disorders, hallucinations, depression, dementia, constipation, GI dysfunction, anosmia
What is the pathological hallmark of parkinsons?
Lewy bodies
How is parkinsons diagnosed?
brain imaging and DaTSCAN
bradykinesia and 1 of: resting tremor, postural instability and rigidity
What are the risk factors for developing Parkinson’s?
men > women
advancing age
positive family history- 5% familial
genes - PARKIN (recessive) and LRRK2 (dominant)
When do you commence treatment for parkinsons?
when the patient feels like the disease is taking over their life
What is first line to treat parkinsons? Why?
Levodopa - enhances cerebral dopamine concentration and stimulates dopamine receptors
What can also be used to treat tremors?
anticholinergics - trihexyphenidyl or clozapine
What are the side effects of levodopa?
nausea
daytime sleepiness
oedema
In what patients should dopamine agonists be avoided in?
patients with a history of addiction, OCD or impulsive personality
