Parksinsons Flashcards
Age of presentation of Parkinson’s ?
45-60
Parkinsonism triad?
Bradykinesia, tremor, rigidity. Usually bilateral but can start unilateral
What happens to tremor in Parkinson’s ?
Disappears with activity
What is rigidity?
Increased resistance to passive movement
What is rigidity like throughout the range of movement ?
Equal throughout
Gait in Parkinson’s ?
Show, shuffling gait
Arms and posture during walking ?
Stopped posture and reduced arm swing
What is speech like ?
may be slow and monotonous. In late stage disease may be slurred, or even lost
Power and sensory loss?
Power remains normal and there is no sensory loss
What other psychiatric conditions associated with Parkinson’s ?
Dementia and depression
Why do you get hallucinations.
A combination of the disease and the drugs used. Often they are not unpleasant
What are kayser fleisher rings seen in?
Wilson’s disease (copper)
Which drugs can cause Parkinsonism?
Drugs (usually dopamine antagonsists)–e.g. prochlorperazine, metoclopramide (antiemetics) phenozanthines, butyrophenones (neuroleptics)
pathological hallmark of parkinsons disease
prominent dopaminergic neurone loss in the substantial nigra with alphasyneuclein containing lewey bodies and lewey neurites
which part of the brain is the substantial nigra found?
basal ganglia
what are upper motor neurone features?
pyramidal weakness and spasticity
triad of parkinsonianism?
bradykinesia, resting tremor and rigidity
Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance?
chorea
what does PD present with?
PD presents with tremor, muscular rigidity, akinesia, rest tremor, and gait and postural impairment
which subtype has the slower rate of progression ?
tremor dominant
non motor features of PD?
olfactory dysfunction, cognitive impairment, psychiatric symptoms, sleep disorders, autonomic dysfuncLon, pain, and faLgue.
when does diagnosis occur in PD?
with the onset of motor symptoms
what is progression of PD characterised by?
progression of motor symptoms
Neuronal loss in PD occurs in many other regions including?
ocus ceruleus, nucleus basalis Meynert, pedunculoponLne and raphe nuclei, dorsal motor nucleus of vagus, amygdala, hyopthalamus
how are lewey bodies formed?
Misfolded α-synuclein,which is insoluble and aggreagated, forms intracellular inclusions (Lewy bodies)
Prolonged muscle spasms and abnormal postures
dystonia
Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance
chorea
a parasomnia characterized by abnormal or disrupLve behaviours (such as talking, laughing, shouLng, gesturing, grabbing, punching, kicking,, sirng up in bed)
Rapid eye movement sleep behaviour
treatment of rapid eye movement sleep disorder?
clonazepam or malatonin
what is the frequency of the rest tremor in parkinsons?
4-6Hz
where are lewey bodies found in parkinsons?
not confined to the brain, they are also present in spinal cord and peripheral nervous system
what are lewey bodies?
misfolded alpha sinuclein, which is insoluble and aggregated. These form intracellular inclusions
what does pigment loss correlate with?
dopaminergic cell loss
greatest risk factor of parkinsons?
age
male to female?
more common in males
greatest genetic risk factor for PD
mutations in GBA
what is treatment in PD aimed at doing ?
enhancing intracerebral dopamine concentrations or stimulate dopamine receptors
which drug class associated with oedema?
dopamine agonists
which drug associated with dyskinesia? (writhing movements)
levodopa
what is the “on-off effect” of levodopa
alterations between periods of good motor symptom control and periods of reduced motor symptom control
PsyChosis in PD is most efficiently managed with
Clozapine
motor symptoms in PD?
bradykinesia
rest tremor
rigidity
postural and gait impairment (stooped posture and show, shuffling gait with reduced arm swing)
Slowness of movement with progressive loss of amplitude or speed during aWempted rapid alternaLng movement of body segments
BRADYKINESIA
how can you assess bradykinesia?
can be assessed by asking the patient to perform some repetitive movements as quickly and wisely as possible
decreased facial expression and eye blinking ?
hypomimia
what happens to rhythmic oscillatory tremor on voluntary active movement
disappears
what is re emerging tremor?
tremor reappears after hands held out
is head tremor typical for PD?
no
what is cog wheel rigidity
“Cogwheel” rigidity occurs when there is also a tremor and is characterized by a “stop and go” effect during a range of motion maneuver. Felt especially at the wrist
why do you get a stooped posture?
impaired postural reflexes
what is the parkinsonian gait like ?
slow, shuffling gait with a narrow base
what is hyposmia?
reduced ability to smell (hypnosemia)
what are premotor symptoms to ask about?
REM sleep behaviour, loss of smell, constipation
exposure to what can be a risk factor for parkinsons?
manganese, pesticides
do you get dementia early in the disease course?
no
investigations for parkinsons?
structural brain imaging possibly structural brain imaging dopamine functional imaging is unable to distnguish PD from other causes of degeneratve Parkinsonism, but should be normal in essenLal tremor, dystonic tremor, psychogenic parkinsonism. positive levodopa challenge genetic testing where appropriate
what is vascular parkinsonism?
parkinsonism affects mainly the lower limbs. rest tremor is uncommon. get a poor levodopa response
does parkinsonism tend to be symmetrical or assymetrical?
symmetrical, although can start unilateral
what drugs can cause parkinsonism?
any drugs that block the action of dopamine (especially neuroleptic drugs)
what improves essential tremor?
alcohol and beta blockers
frequency of essential tremor?
higher frequency (12Hz)
inheritnace pattern of essential tremor?
autosomal dominant
typical onset of essential tremor?
15 years
common cause of degenerative parkinsonism, hot cross bun sign on MRI?
multi system atrophy O+
Symmetric akineLc-rigid syndrome with predominantly axial involvement. Vertical gaze supra nuclear palsy?
progressive supranuclear palsy
Core symptoms include cerebellar gait ataxia, postural / intenLon tremor, variably Parkinsonism, dysautonomia, cogniLve decline of frontal type, and peripheral neuropathy
fragile x tremor ataxia syndrome
useful for managing tremor in drug induced parkinsonism?
procyclidine
which features of parkinsons disease are uncommon in drug induced parkinsonism?
Rigidity and resting tremor
