Parkinsons Disease

Question 1

What is Parkinsons Disease?

Answer 1

Progressive neurological condition

Question 2

What chemical is lacking in Parkinsons?

Answer 2

Dopamine - cells have died

Question 3

What are the 3 main symptoms for Parkinsons?

Answer 3

Tremor
Rigidity
Bradykardia

Question 4

What are other symptoms of Parkinsons?

Answer 4

Tired, pain, depression, constipation

Question 5

How many people are affected by Parkinsons?

Answer 5

1/500 UK, mostly over 50 yrs

Question 6

Is there a cure for Parkinsons?

Answer 6

No

Question 7

What can treatments do for Parkinsons?

Answer 7

Restore level of dopamine in brain by mimicking actions
Brain stimulation
Physical therapy for speech and language

Question 8

What motor symptoms are associated with Parkinsons?

Answer 8

TREMOR - rolling pill movements which spread, seen in resting state
BRADYKINESIS - slow movement or inability to make voluntary and involuntary movements
RIGIDITY - increased muscle tone
POSTURAL INSTABILITY - imbalance, stooped, shuffle
AKINESIA - lacking facial expression, blinking, swallowing

Question 9

What non - motor symptoms are associated with Parkinsons?

Answer 9

AUTONOMIC DYSFUNCTION -
Varied BP
Cardiac disarrythmias
Excessive sweating
lack of sleep
Dry mouth
Constipation

BEHAVIORAL -
Depression
Dementia
Psychosis 
Weight loss
Lack of energy

Question 10

How do we diagnose Parkinsons?

Answer 10

We cant be 100% sure until post mortem confirmation

Question 11

What causes Parkinsons?

Answer 11

Damage/loss of 60% neurones that store and release dopamine in the substantia nigra
Less neurones means less dopamine in striatum of basal ganglia

Question 12

What is dopamine needed for?

Answer 12

Smooth muscle and coordination of body movements

Question 13

What causes the death of the dopamine releasing cells?

Answer 13

Genes

Trauma

Question 14

What are Lewy bodies?

Answer 14

Surviving neurones which are believed to be involved in neuronal damage
They have factors responsible for the development of intraneuronal cytoplasmic fibrillar aggregates of protein alphs - synuclein

Question 15

What reduces the occurance of Parkinsons?

Answer 15

Caffeine
Nicotine
NSAIDS

Question 16

At what point are medications given to Parkinsons sufferer?

Answer 16

When symptoms interfere with level of functioning

Question 17

What medications are given for Parkinsons?

Answer 17

LEVODOPA - crosses BBB and taken up by remaining neurones and is transformed into dopamine. Given alongside drugs that inhibit levodopa being converted to dopamine, leaving more levodopa available, long term not good.
DOPAMINE AGONISTS - bypass nigral neurones and stimulate dopamine receptors directly - Cabergoline but that can lead to IE.
ANTICHOLINERGICS - treat tremors but dont help rigidity
ECSTASY
SURGERY - electrodes to inhibit movement

Question 18

What orofacial symptoms with Parkinsons patients have?

Answer 18

Reduced blink rate
Upward gaze
Lip tongue and eyelid tremors
TMJ pain
cracked teeth
cant retain dentures
reduced smell
drooling
chelitis
Treat with botox to reduce saliva flow

Question 19

How can we make appts better for Parkinsons?

Answer 19

Shorter appts
Morning appts
LA - only 3 cartridges
Chair not flat