Parkinsons disease Flashcards
What is Parkinsons disease?
Neurodegenerative disease: loss of dopaminergic neurones of the substantia nigra, a/w Lewy bodies in the basal ganglia, brain stem + cortex
What triad of symptoms characterises Parkinson’s?
Resting tremor
Bradykinesia
Cogwheel rigidity
What are the aetiological causes of Parkinson’s?
Idiopathic (most common)
Genetic
Give 3 risk factors for Parkinsons
Increasing age
M > F
Pesticide exposure
List 7 non motor symptoms seen in Parkinsons
Autonomic dysfunction: falls, Constipation, Urinary frequency/ urgency, Dribbling of saliva
Sleep disturbance
Anosmia
List 5 signs of Parkinsons
Postural hypotension Gait disorders Hypomimia Quiet voice Smaller hand writing (micrographia)
Describe the tremor in PD
Pill rolling rest tremor
4-6 Hz
Decreased on action
Usually asymmetrical
Describe the gait in PD
Stooped Shuffling Small-stepped gait Reduced arm swing Difficulty initiating walking
Describe the rigidity in PD
Lead pipe rigidity of muscle tone
Superimposed tremor can cause cogwheel rigidity
Rigidity can be enhanced by distraction
What 2 features describe the onset of PD?
INSIDIOUS onset
Unilateral onset
What is meant by the terms “on” and “off” in relation to a PD patient?
ON: moving well, may have dyskinesias
OFF: stiff + bradykinetic
What psychological pathologies may arise with PD?
Depression
Dementia
Psychosis
Describe diagnosis of PD
Clinical dx
Clinical response to dopaminergic therapy is supportive
MRI excludes structural pathology
DaTscan to exclude ddx
Describe 5 drug approaches to managing PD
Levodopa + dopa-decarboxylase inhibitor (Carbidopa)
Dopamine agonists: Ropinerol + Bromocriptine
MAO-B inhibitors: Rasagiline
COMT inhibitors: Entacapone
Anticholinergics: Ophrenadrine reduce tremor in young
