Parkinsons disease Flashcards
Aetiology and risk factors of Parkinson’s disease
Probably some genetic predispositions, but not much FHx. Environment likely to play role
Rare forms of genetic parkinsons
Loss of niagrostriatal dopanergic neutrons->Basal ganglia dysfunction, -overstiumulation of Subthalamic nucleus=> cause most symptoms
Parkinson mimics- (parkinsonism causes)- Progressive Supranuclear palsy, Multiple system atropy, Dementia with lewy, body, drug induced
Risk factors: Age, familial PD
Chronic exposure to metals
Male
Significant head trauma in past
Wilsons disease
Signs and symptoms of Parkinson’s disease?
Key features;
Required (always present): bradykinesia-slowing of movement,
difficulty initiating movement, Micromesia (small movements)
Rigidity-cogwheel especially
Resting tremor 4-6Hz associated REST
starts asymmetrical
Rigidity-Hypertonicity
Postural instability
show as :
Shuffling gait,
less expressive face/loss of face movements (hypomimesis)
Drooling
Weaker voice (hyphonia)
Smaller handwriting (micrographia)
Stooped posture and SHUFFLING GAIT)
Other: Constipation, DEPERESSION, anxiety, dementia
Loss of smell
FYI-Drug parkinson is bilateral usually
Investigations of Parkisons disease
Clinical diagnosis of PD, but dopimanergic agents trial should improve Sx
MRI brain-normal in most idiopathic PD
Functional imagine-less basal ganglia action
DAT Scan-type of PET scan tells a lot
Mx of Parkinsons
First line- If motor sx dominant- Levodopa
if not-Levo, Dopamine Agnist, MAO inhb
give drug holidays if hypomobile gut
Can add another if not improving or a COMT inhbib
Careful, all carry a risk of Hypotension, Personality changes, day time drowsynessn and hallucinations
Impulse control disorder more common with dopamine agonist, pmhx of alcohol
control drool with glypperonium.
Medication exist to counteract Hypotension crisis and day time drowsy
Specific infos about Levodopa, Dopamin agonist and MAO inhibitors
Levodopa-better motor improve, but also more motor SE. Less classic SE.
causes Dry mouth, Hypotension, psychosis
short action-combined with a enzyme inhbitor/COMT inhib to prolong but still–
end of dose sx worse
“on-off”- Big sx variation when active or not
Peak conc- can get chorea when at peak for the dose
DONT STOP when acutely ill-
Dopamine agonist (eg bromocriptine, Cabergoline are ergot derived-high risk of pulm/cardiac fibrosis-monitor with xray n stuf)-
use non ergot derivative
Higher risk of Hallucinations, Hypotension, impulse control disorder
Essential tremor sx and Mx
Usually bilateral tremor with no other parkinsons sx- in younger people
worse on stretch
improve with alcohol and rest (opposite of PD)
usually strong family hx of it
mx with propanolol if annoying
