Parkinsons Disease + Movement Disorders Flashcards
What are some clinical signs of Parkinson’s Disease
Most important (inform diagnosis) Bradykinesia Muscle Rigidity Resting Tremor (4-6Hz) Postural Instability WITH NO CAUSE
Other Anosmia (no smell) Depresion Mask-Like Face Constipation Slow/slurred speech Micrographia Falls Dementia
What kind of diagnosis is Parkinson’s + what investigations can be used for diagnosis?
Clinical diagnosis primarily, but can be a diagnosis of exclusion. DAT (dopamine active transporter) Scans may be used to measure nigrostriatal dopamine activity)
What are the clinical diagnostic criteria for Parkinson’s
Bradykinesia and 1+ of muscle rigidity/resting tremor/postural instability
What are some supportive indicators for Parkinson’s diagnosis
Unilateral onset + persistent asymmetry on side of onset
Progressive nature
Responds well to L-DOPA
L-DOPA induced Chorea (jerky movements)
What conditions give an abnormal DAT scan with Parkinson’s symptoms
Parkinson’s
Multiple system atrophy
Progressive supranuclear palsy
Lewy Body Dementia
What Conditions give a normal DAT scan with Parkinson’s symptoms
Essential Tremor
Drug induced extra pyramidial symptoms
Somatisation (symptoms w/ no organic cause)
Whats the Pathophysiology of Parkinson’s disease
Short: Loss of dopamine-producing cells in the substantitia nigra, the exact cause of which is unknown
Long: Decreased D1-R activation in the striatum causes decreased D2-R activation in the striatum causing increased striatopaladial GABA transmission, causing decreased Globus pallidum externus GABA transmission to the sub-thalamic nuclei causing increase glutamate/aspartate transmission to the SN and Globus pallidus externus respectively, causing increased GABA transmission to the VTL nucleus of the thalamus causing decreased motor cortex activation via glutamate
What are some risk factors for Parkinson’s
Age
Fhx
Non-smoker
Head trauma
Infections (post-encaphalitis parkinsons)
Toxins (pesticides/well water/rural life)
What are some protective factors for Parkinson’s
Cigarettes
Caffeine
What are the Pharmacological managements for Parkinson’s
- L-Dopa + decarboxylase inhibitor (prevent peripheral metabolism) are first-line (replaces dopamine)
- Ropinorole/Rotigotine are sometimes used (dopamine receptor agonists)
- MAO-is, COMT-is (decreased dopamine breakdown) and antimuscarinics like amantadine (combat symptoms) are also used sometimes
Outside of medication, how may Parkinson’s be treated
- CGA
- Social Support
- Education + advice
- OT
- Physio
- Control of non-motor symptoms
What are some non-motor symptoms of Parkinson’s
Constipation
Altered mood
Altered sleep
Autonomic dysfunction (incontinence, sexual impotence, orthostatic hypotension, dysphagia, sweating, dry eyes, drooling)
What are some key rehabilitation strategies used for Parkinson’s disease
- Avoiding multitasking
- Breaking complex tasks into smaller components
- Use of external cues to initiate/maintain movement/action
L-DOPA side effects
N+V Postural Hypotension (DA acts as a false SNS transporter) Hallucinations/confusion Resitance (10 years effective range) Dyskinesia Motor Fluctuation
Dopamine Receptor agonists (Ropinorole/Rotigotine) Side effects
Nausea Postural Hypotension Hallucinations Ankle Swelling Motor Disturbance (wearing off, dyskinesia, freezing) Somnolence (drowsiness) Impulse control disorder (gambling, hypersexuality, binge eating, compulsive shopping, collecting assembling and taking apart ect) Pain Drooling Dermatitis Dementia Apathy Delerium Incontinence Vivid dreams Restless legs
