Parkinsons + anxiety Flashcards
What is GAD 2?
Over last 2 weeks, how often have you felt:
Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Score >3 = anxiety disorder
Typical age of onset for Parkinsons
65 y/o
Pathology of Parkinsons
Mitochondrial DNA dysfunction
Degeneration of dopaminergic neurons in substantia nigra pars compacta
Decreased dopamine levels
RF for Parkinsons
Males, increasing age, pesticide exposure
Symptoms of Parkinsons
Bradykinesia/ hypokinesia
Tremor at rest
Postural instability + muscular rigidity
Prosody (poor decoding of emotional content of speech) Sense of smell reduced Constipation Visual hallucinations Depression + dementia Sleep disorders
Signs of Parkinsons
Tremor, worse at rest - pill rolling
Rigidity - cogwheel rigidity felt during rapid pronation/ supination
Bradykinesia - monotonous hypophonic speech, micrographia, shuffling gait, expressionless face (hypomimesis)
What is Wilsons disease?
Differential for Parkinsons
Earlier onset with characteristic Kayser-Fleischer rings + hepatitis
What are the signs of progressive supranuclear palsy?
Early postural instability and vertical gaze palsy +- falls, rigidity of trunk > limbs, symmetrical onset, speech and swallowing problems, little tremor
What are the signs of multiple system atrophy?
Early autonomic features i.e. impotence/ incontinence, postural low BP, cerebellar and pyramidal signs, rigidity >tremor
What are the signs of corticobasal degeneration?
Akinetic rigidity involving one limb, cortical sensory loss, apraxia (even autonomous interfering activity by affected limb/ alien limb)
What are the signs of vascular parkinsonism?
Pyramidal signs (legs) e.g. in diabetic/ hypertensive pt who falls or has gait problems, with no festination
Management of Parkinsons
Levodopa - start late due to end dose wearing off + dyskinesias
Dopamine agonists + MAO-B inhibitors = can delay starting levodopa
Complications of Parkinsons
Infections Aspiration pneumonia Falls Contractures Bowel disorders
