Parkinsons Disease Flashcards
Which type of movement disorder is it?
Hypokinetic
Definition
Motor and non motor difficulties arising from brain dysfunction through the reduced production of dopamine
There is increased/decreased production of dopamine
Decreased
It affects a specific part of the brain. True or false?
False
- it affects the whole brain
Are there any diagnostic tests available at an early/prodromal state?
No
- b the time motor features are detected, the disease is well advanced
Pathogenesis
Degeneration of substantia nigra
Substantial loss of dopaminergic neurones in the substantial nigra pars compacta
What would a cross section through the brain stem show
Loss of normally black pigment in the substantial nigra
Locus coeruleus
Pigment loss in the substantial nigra correlates with ?
Loss of domaminergic cells
What pathological feature may remaining neurones show?
Lewy bodies
What are lewy bodies?
Eosinophilic alpha-syunclein containingg inclusion granules
What do lewy bodies look like?
Dense core with a surrounding halo
Cause
Unknown
More common in males/females
Males
More common in younger/older population?
Older population
What is parkinsonism
Symptoms that are compatible with parkinson disease but the underlying cause may be different
Which symptoms tend to arise first - motor symptoms or non motor symptoms?
Non-motor symptoms
Non motor features
Sleep disorders Hallucinations Constipation Fatigue Depression Cognitive impairment Anosmia Pain Bladder problems Loss of facial expression (hypomimia) Soft speech (hypophonia)
Motor features
Resting tremor Rigidity Bradykinesia Gait abnormalities Postural instability
Motor features - resting tremor
When patient is relaxed and sits down there is a pill rolling tremor
- opposing circular movements of the thumb and index finger
Motor features - the resting tremor is symmetrical. True or false?
False
- asymmetrical
Motor features - the resting tremor vanishes with active movement. True or false?
True
Motor features - rigidity. There is increased/decreased muscle tone?
Increased
Motor features - movements are stiff. True or false?
True
Motor features - bradykinesia
Slowness of movements
Difficulty initiating movements
How can you assess bradykinesia?
Ask the patient to perform some repetitive movements as quickly as possible
Motor features - gait abnormalities
Shuffling gait short stepped gait slow gait absence of swinging arms whilst walking slow turning with multiple steps
Motor features - postural instability
Pull the patient back slightly and they fall backwards
Cerebellar signs should be present/absent?
Absent
Diagnostic tests are required to confirm the diagnosis. True or false?
False
- clinical diagnostic test and diagnostic tests are not usually required
Confirmation of diagnosis
Parkinsonism - bradykinesia - resting tremor - rigidity - gait abnormality No alternative explanation for presentation Dopamine responsiveness
When should treatment be initiated?
When symptoms cause disability or discomfort
Management
Drugs that increase dopamine concentration or directly stimulate dopamine receptors
- levodopa
- dopamine agonists
- monoamine oxidase type B inhibitors
Side effects of dopamine stimulating drugs
Nausea
Daytime somnolence
Impulse control disorders (pathological gambling)
Drug induced psychosis
Levodopa crosses the BBB. True or false?
True
What is levodopa converted to in the brain?
Dopamine
Name 3 examples of dopamine agonists
Pramipexole
Ropinirole
Bromocriptine
Individuals with parkinsons disease have a decreased life span. True or false?
True
Vascular parkinsonism predominantly affects which part of the body?
Lower limbs
How does drug induced parkinsonism arise?
Caused by any drug that blocks the action of dopamine
Which 2 of the following medications should be avoided in patients with Parkinson’s disease? Domperidone Quetiapine Haloperidol Metochlopramide
Haloperidol
Metochlopramide
