Parkinsons Disease

Question 1

outline the main risk factors for Parkinsons

Answer 1

age >65
male
pesticide exposure/occupation of farmer

Question 2

what are the 2 genes associated with Parkinsons disease

Answer 2

LRRK2 - autosomal dominant pattern

parkin - autosomal recessive pattern

Question 3

what is the underlying pathology of parkinsons

Answer 3

degeneration of dopaminergic neurones within the substantia nigra
accumulation of Lewy bodies

Question 4

what is the triad of the 3 extra-pyramidal features of parkinsons

Answer 4

tremor
hypertonia
bradykinesia

Question 5

describe the tremor associated with parkinsons

Answer 5

pill rolling tremor - thumb and finger tremor

Question 6

outline some of the motor features of parkinsons (TRAP)

Answer 6

tremor
rigidity
akinesia - impaired power of voluntary movements
postural instability

Question 7

describe the rigidity associated with parkinsons

Answer 7

cogwheel - movements of limbs catch

Question 8

describe the gait abnormalities with parkinsons

Answer 8

shuffling gait, unilateral reduced arm swinging, bend forward when walking, difficulty turning

Question 9

outline some of the non-motor features of Parkinsons

Answer 9

GI dysfunction and constipation 
REM sleep disorders
hallucinations 
depression 
hyposmia 
cognitive impairment 
drooling
mask like expressionless face

Question 10

which features appear first, motor or non-motor features

Answer 10

non-motor, vague symptoms and can be present for up to 20 years before motor symptoms begin

Question 11

how is parkinsons diagnosed

Answer 11

clinical diagnosis from history and examination

Question 12

what conditions must be excluded before Parkinsons is diagnosed

Answer 12

fronto-temporal dementia

cerebellar disease

Question 13

what is a Dat-scan and how is it useful for diagnosis

Answer 13

radioactive iodine scan used to look at substantia nigra, normally appears comma shaped but in Parkinsons it is pear shaped

Question 14

early onset bulbar problems, dementia, prominent eye movements and autonomic problems are features of parkinsons true/false

Answer 14

false - if these are present suspect a different condition

Question 15

what are some of the drugs used to manage symptoms of parkinsons

Answer 15

levodopa - dopamine precursor

carbidopa - peripheral antagonist to prevent breakdown

Question 16

what is one of the disadvantages of parkinsons drugs

Answer 16

they have diminishing effects after 5-10 years so only recommended when the disease is causing extreme disability

Question 17

what drugs can be used to treat mild symptoms of parkinsons

Answer 17

monoamine oxidase B inhibitors eg selegiline

dopamine agonists

Question 18

what are some of the side effects of levodopa

Answer 18

nausea/vomiting
dyskinesia
sudden off states - reduced impulse control, excessive spending, psychosis

Question 19

which anti-emetic is recommended for managing nausea associated with levodopa and why

Answer 19

domperidone is selective to peripheral dopamine receptor so won’t reduce levodopa activity in the brain

Question 20

what are the 2 main causes of secondary parkinsonism

Answer 20

vascular - Hx of diabetes, mainly lower limbs affected

drug induced - coarse postural tremor, asymmetrical

Question 21

what types of drugs cause drug-induced parkinsonism

Answer 21

anti-emetics

anti-psychotics