Parkinsons disease Flashcards
Pathology of PD
neurodegeneration of dopaminergic neurons in pars compacta of the substantia nigra (SNpc) of basal ganglia
Cardinal features of PD (triad)
Bradykinesia
Resting tremor (4-6Hz)
Rigidity hypertonia
Motor features of PD
Bradykinesia Tremor rigidity shuffling gait loss of arm swing stooped postural instability difficulty initiating gait difficulty turning low amplitude finger tapping
Non-motor features of PD
DEPRESSION dementia anosmia constipation REM behavioural disorder hypomimia micrographia hypersalivation hallucinations GI dysfunction
Causes of Parkinsonism
idiopathic PD
drugs: metaclopramide, haloperidol, lithium, B blockers
environmental/chemical exposure
MS, Wilson’s, post encephalitis
management of PD
Levodopa +-carbidopa
dopamine agonists
PT, OT, S+LT
describe dementia in Parkinsons
dementia:
- less than 1 year = DLB
- more than 1 year = PDD
Parkinsonism has a/symmetrical tremor
Parkinsons disease has a/symmetrical tremor
parkinsonism is symmetrical
parkinsons disease is asymmetrical
on macroscopic pathological specimens what can be noted
loss of normal black pigment in the substantia nigra (and locus coeruleus)
what is a neurohistological hallmark of PD
Lewy bodies containing a-synuclein
however, not specific to PD
what are the subtypes of motor features in PD
tremor dominant PD
non-tremor dominant PD
mixed
describe tremor dominant PD and what is the prognosis
relative absenceof other motor symptoms
slower rate of progression
describe non-tremor dominant PD
akinetic rigid syndrome and postural instability gait syndrome
imaging is part of the routine diagnostic work up in PD, true or false
false, PD is largely a clinical diagnosis
it is only used when there is uncertainty
which imaging types are structural
MRI
CT
which imaging types are functional
PET
SPECT
DaTSCAN
Risk factors for developing PD
advancing age
positive family history + genetics
male gender
environmental factors: pesticides, rural living, B blocker, prior head injury
monogenetic forms of PD
LRRK2 - AD
PARKIN - AR
what is the function of symptomatic treatments
increase dopamine concentrations or stimulate dopamine receptors
when should treatment be initiated
when symptoms cause disability or discomfort
with the aim of improving quality of life
to which treatment do bradykinesia and rigidity respond to
dopaminergic treatment
tremor is not responsive to dopamine therapy, true or false
true
which treatments are effective for tremor
anticholinergics
trihexyphenidyl
clozapine
what is levodopa
precursor of dopamine
what is a dopa decarboxylase inhibitor DDI and what is the benefit
reduced peripheral availability of levodopa
reduces side effects
what is usually prescribed with levodopa
and what is the indication
carbidopa (DDI)
motor symptoms
dopamine agonists improve motor symptoms in early/late disease and have more/less side effects
early
more side effects
classification of dopamine agonists
Ergot
Non-Ergot
list ergot derived D agonists and what are their side effects
bromocriptane
cabergoline
pergolide
cardiac valvulopathy and serosal fibrosis
list non-ergot D agonists
apomorphine
pramiprexole
ropinirole
rotigotine
side effects of dopamine agonists
N+V daytime somnolence Impulse Control Disorders ICD peripheral oedema dizziness hallucinations constipation
Levodopa provides the greatest symptomatic benefit, true or false
true
Longterm levodopa use is associated with __ ?
motor complications
- dyskinesia
- motor fluctuations
what are motor fluctuations
alterations between periods of good and bad motor symptom control
what are non-motor fluctuations
alterations between periods of good and bad non-motor symptom control
what is dyskinesia and when does it develop
involuntary choreiform or dystonic movements which occur when levodopa concentrations are at their maximum
develops at the beginning or end of levodopa dose
what are MAO B inhibitors used for
motor symptoms
examples of MAO B inhibitors
selegiline
rasagiline
are there diagnostic tests for PD at an early stage
no
resting tremor vanishes with active movement, true or false
true
in clinical practice when is resting tremor best observed
when the patient is focussed on a task eg counting backwards from 100
rigidity is velocity dependent, true or false
false
spasticity = velocity dependent
rigidity = non-velocity dependent
what is festination
very fast succession of steps and difficulties stopping
what are the Parkinsons plus syndromes and are they the same as Parkinsons disease
progressive supranuclear palsy
multiple system atrophy
not the same as PD
what is vascular parkinsonism
parkinsonism that predominantly affects the lower limbs
resting tremor is uncommon
drug induced parkinsonism tends to be a/symmetrical
symmetrical
drug induced parkinsonism tends to be a/symmetrical
symmetrical
what is multi system atrophy MSA and its core triad
dysautonomia - postural hypotension…
cerebellar features
Parkinsonism
jerky postural tremor
MRI findings of MSA?
cerebellar and pontine atrophy “hot cross bun” sign, hyperintense rim surrounding putamen
what is progressive supranuclear palsy PSP
ait and balance impairment vertical gaze supranuclear palsy pseudobulbar symptoms eyes wide open no response to levodopa
what type of drug is amantadine
NMDA antagonist
