Parkinsons disease Flashcards
What is parkinsons
progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra
What is the classic triad of symptoms seen in parkindons
bradykinesia
tremor
rigidity
What is the epidemiology of parkinsons
twice as common in men
mean age of diagnosis is 65 years
What are features of drug induced parkinsonism
motor symptoms - rapid onset and symmetrical
rigidity and rest tremor are uncommon
What are key symptoms of parkinsons
parkinson’s TRAPS the patient
tremor - pill rolling mostly at rest
Rigidity - lead pipe and cogwheel
Akinesia/braydkinesia- short,shuffling steps with reduced arm swinging
Postural instability
What are some other symptoms
flexed posture
micrographia
psychiatric features - depression , dementia etc
REM sleep behaviour disorder
fatigue
What investigations are required to make a diagnosis
Clinical diagnosis
What imaging does NICE recommend
use of SPECT imaging when difficult to differentiate from essential tremor
DaTscan
-PET etc are NOT recommended
What is first line medication given to patients if motor symptoms are affecting QoL
LEVODOPA - combined with carbidopa
What medication can be given if motor symptoms are not affecting QoL
dopamine agonist
monoamine oxidase B inhibitor
What can be given for persistent daytime sleepiness
MODAFINIL
What can be given for persistent orthostatic hypotension
MIDODRINE
What can be given for drooling
GLYCOPYRRONIUM BROMIDE
What are some common adverse effects of levodopa
dry mouth
anorexia
palpitations
postural hypotension
psychosis
What are other medications used for parkinsons
ropinirole- dopamine agonist
entacapone- COMT inhibitor
bromocriptine- dopamine agonist
