Parkinson's

Question 1

What is the 2nd MC neurodegenerative disease?

Answer 1

Parkinson’s

Question 2

What population is most affected by Parkinson’s?

Answer 2

M > W, mean age = 60

Question 3

What are the main RFs for Parkinson’s?

Answer 3

• Family hx
• Depression
• Constipation
• Pesticide exposure
• High consumption of dairy products

Question 4

Define: parkinsonism

Answer 4

Bradykinesia w/ rigidity &/or tremor

Question 5

What neuro components are involved in Parkinson’s?

Answer 5

• Basal ganglia

- Thalamus

Question 6

Describe the basal ganglia

Answer 6

• AKA extrapyramidal system

- Paired masses of gray matter within the white matter of the cerebral hemispheres

Question 7

What is the basal ganglia composed of?

Answer 7

Subcortical nuclei that include:

• striatum
• subthalamic nucleus (STN)
• globus pallidus pars externa (GPe)
• globus pallidus pars interna (GPi)
• substantia nigra pars compacta (SNc)

Question 8

What are the functions of the basal ganglia?

Answer 8

• Subconscious aspects of voluntary movement
• Regulate muscle tone
• Coordinate accessory movements (s/a swinging w/ walking or gesturing while speaking)

Question 9

What does the thalamus do?

Answer 9

• Communicates w/ motor cortex

- Excite the motor cortex so it is kept in inhibitory state by GPi

Question 10

The basal ganglia is composed of what 2 pathways?

Answer 10

1. Direct: Makes movement

2. Indirect: Inhibits movement, alters level of inhibition on thalamus

Question 11

What are the cardinal features of Parkinson’s ?

Answer 11

• Tremor
• Rigidity
• Bradykinesia
• Gait impairment or postural instability

Question 12

What are the characteristics of atypical parkinsonism?

Answer 12

More widespread

• Early speech & gait impairment
• Absence of rest tremor
• No motor asymmetry
• Poor or no response to levodopa
• Aggressive clinical course

Question 13

What causes secondary parkinsonism?

Answer 13

• Drugs (dopamine-blocking)
• Stroke
• Tumor
• Infection
• Exposure to toxins
• Can be a feature of other degenerative d/o (s/a Wilson dz, Huntingtion dz)

Question 14

How do you dx Parkinson’s? What criteria is used?

Answer 14

• UK Brain Bank Criteria: Parkinsonism associated w/ rest tremor, asymmetry, & good response to levodopa.
• Dx clinically!

Question 15

What imaging tests should you use for dx of Parkinson’s?

Answer 15

• Brain MRI (excludes other diseases)
• DaTscan (if MRI is inconclusive)
• PET

Question 16

What other dx testing can be used for dx of Parkinson’s?

Answer 16

Genetic testing

• Mutations of LRRK2 gene
• Mutations of parkin gene (in < 40yo)

Question 17

When should you start pharcotherapy tx in Parkinson’s ?

Answer 17

• Effect on dominant hand
• Interference w/ work, ADLs, or social & leisure fuction
• Severity of bradykinesia or gait disturbance

Question 18

What meds are used to tx Parkinson’s?

Answer 18

• Levodopa: 1st line, GOLD standard
• Dopamine agonists
• MAO-B inhibitors
• Anticholinergics
• Amantadine

Question 19

Describe dopamine agonists

Answer 19

Often 1st line, but most pts will require levodopa eventually

Question 20

What is surgical tx for Parkinson’s?

Answer 20

Deep brain stimulation: electrode placed into target area & connected to stimulator inserted SQ over chest

Question 21

What is the MOA/effect of deep brain stimulation?

Answer 21

• Disrupts abnormal signal associated w/ PD & motor complicaitons
• Targets STN or GPi

Question 22

What are non-dopaminergic features?

Answer 22

• Anxiety, panic attacks, depression
• Psychosis
• Mild cognitive impairment &/or dementia
• Autonomic, sleep, or gait disturbances