Parkinsons' disease

Question 1

What is Parkinsons’ disease?

Answer 1

Neurodegenerative movement disorder in which there is reduced dopamine, characterised by bradykinesia, resting tremor and rigidity.

Question 2

Describe the aetiology of parkinson’s disease?

Answer 2

3% >65 years - increasing age.
Genetics
Males 1.5x as common
Environment: pesticides, mitochondrial toxins causing oxidative stress.
(lecture 13.3.18, Bandmann)

Question 3

What is essential tremor?

Answer 3

5% of >65 year olds have ET. It is age-related. Treated with beta-blocekrs, anti-epileptic drugs and deep brain stimulation.

Question 4

Which disorders are caused by necrosis of basal ganglia cells?

Answer 4

Parkinsons

Huntingtons

Question 5

Smoking decreases the risk of which conditions?

Answer 5

Ulcerative colitis

Parkinsons

Question 6

Give 3 symptoms of parkinson’s disease.

Answer 6

Rigidity causing aches and pains
Depression/anxiety (50%)
Fatigue
Bradykinesia - difficulty writing/dressing etc.
Gradual worsening
Symptoms of anosmia as olfactory bulb is affected early.
ASYMMETRICAL

Question 7

Describe the diagnostic criteria for Parkinsons.

Answer 7

Bradykinesia plus 1 of:
resting tremor (pill-rolling)
muscular rigidity (due to extrapyramidal involvement)
Postular instability.

Question 8

What is a DaTSCAN used for?

Answer 8

Dopamine transporter scan

Uses SPECT or PET to assess nigrostriatal cell loss. Distinguishes PD from other causes of drug-induced parkinsonism.

Question 9

Describe the management of PD.

Answer 9

Educate and explain. Encourage physical activity. Reassure the patient that disease will not progress overnight, they have about 10 years before wheelchair needed.
Pharmacological: aim to replace dopamine: L-dopa/dopamine agonists, but not necessary until symptoms occur.
Treat motor and non-motor symptoms (depression <40%)

Question 10

Describe the pathology of PD.

Answer 10

1. Loss of dopaminergic neurons
2. Intracytoplasmic inclusion bodies (=Lewy bodies)
   * important*

Question 11

How does L-dopa work?

Answer 11

L-dopa is combined with a dopa carboxylase inhibitor to reduce peripheral nerve effects such as nausea and hypotension. The response is often dramatic. Different preparations can be used:
Morning: dispersible dose
Day
Slow-release