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PBLs > Week 20 - Parkinsons Disease > Flashcards

Week 20 - Parkinsons Disease Flashcards

1
Q

What are some protective factors in Parkinson’s disease?

A

Smoking
Caffeine
Physical activity

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2
Q

What are some risk factors of Parkinson’s disease?

A

Family history
Previous head injury

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3
Q

What is multiple systems atrophy?

A

a rare condition where the neurones of various systems in the brain degenerate, including the basal ganglia.
• The degeneration of the basal ganglia leads to a Parkinson’s presentation.
• Degeneration in other areas leads to autonomic dysfunction (causing postural hypotension, constipation, abnormal sweating and sexual dysfunction) and cerebellar dysfunction (causing ataxia).

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4
Q

What is Lewy body dementia?

A

a type of dementia associated with features of Parkinsonism. It causes a progressive cognitive decline. There are associated symptoms of visual hallucinations, delusions, REM sleep disorders and fluctuating consciousness.

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5
Q

What are Lewy bodies?

A

Protein deposits inside neurones

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6
Q

Patient loses their memory and has difficulty learning new information. What does this suggest?

A

Lewy body dementia

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7
Q

What is progressive supranuclear palsy?

A

a condition that causes both dementia and problems with movement.
• The word ‘supranuclear’ refers to the parts of the brain just above the nerve cells that control eye movement.

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8
Q

What are the symptoms of progressive supranuclear palsy?

A

○ they may find it difficult to move their eyes in the direction they want to look – particularly up or down
○ their eyes may not co-ordinate with each other, which causes blurred or double vision
○ their eyelids may not open normally and may become stuck shut.

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9
Q

Progressive supranuclear palsy affects people of what age?

A

Over 60

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10
Q

What is corticobasal degeneration?

A

• A rare condition in which areas of your brain shrink and your nerve cells degenerate and die over time.
• The disease affects the area of the brain that processes information and brain structures that control movement.
• This degeneration results in growing difficulty in movement on one or both sides of your body.

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11
Q

what are the causes of corticobasal degeneration?

A

build up of tau in the brain cells
2nd most common is atypical alzheimers disease
progressive supranuclear palsy
picks disease

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12
Q

what are some causes of tremor?

A

medicines e.g. salbutamol
heavy metals
caffeine
thyroid disorder
liver or kindney failure
diabetes
stress/anxiety
parkinson

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13
Q

what are the features of a parkinsonian tremor?

A

asymmetrical
at rest
3-7Hz
improves with intentional treomr
no change with alcohol

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14
Q

which tremor improves with alcohol?

A

essential tremor

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15
Q

what are the features of an essential tremor?

A

symmetrical - bilateral
6-12Hz
worse on action/posing
improves with alcohol

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16
Q

what type of tremor is a cerebellar tremor?

A

intention tremor
<5Hz

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17
Q

what can cause a cerebellar tremor?

A

cerebellar damage/infarct e.g. stroke
chronic alcohol use e.g. Korsakoffs syndrome or wernikes encephalopathy
tumor or space occupying lesion

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18
Q

what is a psychogenic tremor?

A

Can appear as any kind of tremor
Symptoms vary and may fluctuate
Tremor may increase when px pays attention to it and disappear when they are distracted
May be caused by stress and anxiety

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19
Q

what is a physiological tremor?

A

Not generally caused by neurological disease but by a reaction to
* certain drugs i.e salbutamol or sympathomimetics
* Alcohol withdrawal
* Hyperthyroidism
* Hypoglycaemia
* Hyperbilirubinemia - asterixis
Hypercapnia - asterixis

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20
Q

what is the triad of motor symptoms for parkinsons?

A

tremor
rigidity
bradykinesia

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21
Q

what non-motor symptoms are associated with PD?

A

○ Pain.
○ Fatigue.
○ Low blood pressure.
○ Restless legs.
○ Bladder and bowel problems.
○ Skin and sweating.
○ Sleep.
Eating, swallowing and saliva control.

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22
Q

what is bradykinesia?

A

Bradykinesia means slowness of movement and speed (or progressive hesitations/halts) as movements are continued.

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23
Q

what is rigidity?

A

Rigidity is when muscles become stiff or inflexible. If this happens to the muscles in your face, it’s called facial masking or a Parkinson’s mask.

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24
Q

how is rigidity caused?

A

Rigidity is caused by dysfunction of extrapyramidal pathways, most commonly the basal ganglia, but also as a result of lesions of the mesencephalon and spinal cord.

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25
Q

what is it called when someone has a tremor and rigidity?

A

cogwheel rigidity

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26
Q

what is dyskinesia?

A

involuntary, erratic, writhing movements of the face, arms, legs or trunk.

e.g. chewing, sucking, tongue protrusion

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27
Q

when does dyskinesia occur in PD?

A

after many years of treatment with levadopa

28
Q

what is chorea?

A

movement disorder that causes sudden, unintended, and uncontrollable jerky movements of the arms, legs, and facial muscles.
Can interfere with speech, swallowing, posture and gait, disappears in sleep.

29
Q

what is the cause of chorea?

A

overactivity of dopamine in the areas of the brain that control movement

Functional dysregulation of the basal ganglia motor circuit, where the final thalamic-cortical output is increased –> increased movement and chorea.

Disruption of basal ganglia: structural damage, selective neuronal degeneration, neurotransmitter receptor blockade, metabolic derangements, or autoimmune conditions.

30
Q

what is the most common cause of chorea?

A

Huntingtons

31
Q

what is athetosis?

A

abnormal muscle contraction which causes involuntary writhing movements.

Slow, continuous, involuntary writhing movement that prevents maintenance of stable posture.

usually in distal muscles e.g. hands
often seen in cerebral palsy

32
Q

what is the cause of athetosis?

A

damage to the corpus striatum (caudate and putamen) in basal ganglia which is responsible for motor control.

33
Q

what is hemiballismus?

A

hyperkinetic involuntary movement disorder characterized by intermittent, sudden, violent, involuntary, flinging, or ballistic high amplitude movements involving ipsilateral arm and leg (one side of the body).

arm is affected more than the leg

34
Q

what is the cause of hemiballismus?

A

dysfunction of CNS of contralateral side. Lesion in the contralateral subthalamic nucleus (STN). STN important modulator of basal ganglia output.

35
Q

what is dystonia?

A

neurological movement disorder.

Involuntary muscle spasms and contractions.

Movements usually slow, repetitive and cause unusual, awkward and sometimes painful postures

Twisting

Tremor often associated

36
Q

what is the cause of dystonia?

A

abnormality/damage to basal ganglia.

37
Q

what is myoclonus?

A

rapid and brief movements
can often be epileptic in nature

38
Q

what are tics?

A

rapid and often repetitive coordinated movements at irregular intervals

39
Q

what is ataxia?

A

unsteady, wide gait
wobbly
poor balance and coordination

40
Q

what are the 4 main dimensions to quality of life?

A

A. Psychological (mood and emotional distress)
B. Social (relationships, social and leisure activities)
C. Occupational (paid, and unpaid work)
D. Physical (mobility and pain)

41
Q

what is the first line treatment of parkinsons disease? give an example

A

levodopa + a dopa decarboxylase inhibitor

e.g. levodopa and carbidopa = co-careldopa (sinemet)

e.g. benzerazide + levodopa

42
Q

how does levodopa work?

A
  • Works as a dopamine precursor that can cross the BBB and is converted to dopamine in the brain
    By increasing dopamine levels it helps alleviate motor symptoms.
43
Q

why isn’t levodopa taken alone to treat parkinsons?

A

levodopa is rapidly converted to dopamine in the bloodstream, leading to significant side effects and reduced effectiveness.

44
Q

what are dopa decarboxylase inhibitors and what do they do?

A

they inhibit an enzyme called dopa decarboxylase which is responsible for the conversion of levodopa to dopamine outside of the brain.

if they arent used levodopa -> dopamine and leads to more side effects and its less effective

By preventing this conversion in the bloodstream, carbidopa and benzerazide allow more levodopa to reach the brain, where it is converted to dopamine and helps alleviate the symptoms of Parkinson’s disease.

45
Q

name 2 dopa decarboxylase inhibitors?

A

carbidopa
benzerazide

46
Q

what is a disadvantage of levodopa therapy?

A

Long-term use can lead to motor fluctuations and dyskinesias.

47
Q

what is a dopamine agonist?

A
  • Works by directly stimulate dopamine receptors in the brain
    Mimic’s the action of dopamine and help alleviate symptoms.
48
Q

give some examples of dopamine agonists?

A

Pramipexole
Ropinirole
Rotigotine.

49
Q

what is a MAO-B inhibitor?

A
  • Work by blocking the breakdown of dopamine in the brain
    Helps to increase and maintain dopamine levels, providing symptomatic relief and slowing disease progression
50
Q

give some examples of MAO-B inhibitors?

A

Selegiline
Resagiline

51
Q

when are MAO-B inhibitors used?

A

Often used as an additional therapy in the later stages of the disease after long term levodopa use

52
Q

what are COMT inhibitors?

A
  • Work by preventing the breakdown of levodopa in the peripheral tissues.
    By prolonging the availability of levodopa in the brain, these drugs enhance the therapeutic effect of levodopa and reduce motor fluctuations.
53
Q

give some examples of COMT inhibitors?

A

Entacapone
Tolcapone

54
Q

when are COMT inhibitors used?

A

Often used as an additional therapy in the later stages of the disease after long term levodopa use

55
Q

what are anticholinergics?

A
  • Help balance the levels of acetylcholine and dopamine in the brain
    Can be beneficial in managing tremors and other motor symptoms
56
Q

give some examples of anticholinergics

A

Trihexyphenidyl
Benztropine Orphenadrine
Procyclidine Biperiden

57
Q

what antiemetic is not given in parkinsons?

A

metaclopramide

58
Q

what non-pharmalogical interventions can help in PD?

A
  • Physical therapy
    • Occupational therapy
      Deep brain stimulation
59
Q

what is the function of the cerebellum?

A

coordinates movement
controls posture, balance & fine motor movements
involved in motor learning

60
Q

what is the vermis and what is its function?

A

Runs along the midline of the cerebellum.
Involved with posture, limb movement and eye movements.

61
Q

what is the function of the vestibulocerebellum?

A

Maintains equilibrium, balance and posture.

62
Q

what are the 3 cerebellum peduncle?what is the main function of the peduncles?

A

superior
middle
inferior

The cerebellum communicates with the rest of the nervous system via the cerebellum peduncles:

63
Q

how does information leave the cerebellum?

A

peduncles
then through the purkinje cells
these cells project into the deep cerebellar nuclei
the information is then sent to the brain stem and thalamus
this can the influence motor areas of the cortex or decending motor tracts to modify movement

64
Q

what are the main inputs and outputs of the basal ganglia?

A

inputs
- caudate
- putamen

outputs
- globus pallidus
- substantia nigra

65
Q

what is the function of the basal ganglia?

A

executes smooth movement
doesn’t independently cause movement, it initiates movement in other areas like the motor cortex

PBLs (19 decks)

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