Parkinsons disease Flashcards
Parkinson’s disease pneumonic
T - tremor R - rigidity A - akinesia P - postural instability P - postural hypotension S - sleep disorders
P - psychosis
D - depression / dementia
hallmark of PD
dopaminergic neuron loss in substantia nigra pars compacta
Classic tremor in PD
pill rolling tremor
tremor @ rest - vanishes with movement
is head tremor typical in PD?
no
Rigidity + rest tremor = ?
cog-wheel rigidity
PD - narrow or wide based gait?
narrow
greatest genetic RF in PD
GBA mutation
tobacco smoking, NSAIDs, CCB use, alcohol »_space; increased or decreased risk of PD?
decreased
Treatment of PD
young + fit @ onset
- Da agonists - ropinorole, pramipexole
- MOABI - rasagiline, selegiline
- L-DOPA
frail
- L-DOPA
- MOABI
PD + dementia > Rx =?
Rivastigmine
drug class good for tremor in PD
anticholinergics
1st line for psychosis in PD
clozapine
antipsychotics can worsen PD!
S/E of both dopamine agonists and levodopa
daytime somnolence and oedema
Levodopa - end of dose effect tx?
COMT inhibitor
when should dopamine agonists be avoided?
history of addiction, OCD
elderly due to hallucinations s/e
what class of drugs is most associated with drug induced parkinsonism
antipsychotics
which part of the body does vascular parkinsonism predominantly affect
lower limbs
rest tremor in vascular parkinsonism
uncommon
progressive supranuclear palsy
presents similarly to parkinsons with gait and balance impairment
rarely see tremor
inability to make vertical saccades
NO response to levodopa
presentation of Fragile X tremor ataxia syndrome
late onset (>50)
postural/intention tremor
decreased frontal cognition
peripheral neuropathy
- triad of multi system atrophy
- MRI feature?
dysautonomia
cerebellar features
parkinsonism
MRI: hot cross bun sign
