Parkinson's disease Flashcards Preview

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Flashcards in Parkinson's disease Deck (21):
1

What are symptoms of hyperkinetic movement disorders?

Dystonia
Tics
Myoclonus
Chorea
Tremor

2

What are the cardinal motor symptoms of PD?

Resting tremor
Slowness of movement
Stiffness/ rigidity - bradykinesia

3

What is the basic pathogenesis of PD?

Reduction of dopaminergic neurones in the pars compacta region of substantia nigra of the basal ganglia
Lewy bodies with alpha synuclein

4

What non-motor symptoms are assoc with PD?

Sleep disorders; REM behavioural disorder
Hallucinations
GI disturbances; constipation
Bladder problems
Pain
Depression
Cognitive impairment
Dementia
Anosmia

5

Does parkinson's just affect the basal ganglia?

No - lewy bodies can be seen across the whole cortex

6

What are the 2 subtypes of PD?

Tremor dominant with relative absence of other motor symptoms
Non-tremor dominant such as akinetic rigid syndrome and postural instability gait disorder
Mixed phenotype

7

Which subtype of PD has a better prognosis?

Tremor dominant; slower rate of progression and less functional disability

8

What is the diagnostic criteria for PD?

Bradykinesia with one or more of:
Resting tremor of 4-6 Hz
Rigidity; cog wheel or lead pipe
Postural instability not cause by primary visual, vestibular or cerebellar pathologies

9

What are some additional motor symptoms of PD that are not included in the diagnostic criteria?

Stooped, fixed posture
Dystonic posture
Hypomimia
Shuffling gait
Short stepped gait

10

What 3 things are required for a confirmation of PD?

Parkinsonism features
No alternative explanation
Dopamine responsiveness

11

What would make you think that a diagnosis of PD is LESS likely?

Early onset bulbar issues
Dementia and hallucinations
Preferential involvement of lower limbs
Prominent eye movement disorder; problems with vertical gaze suggesting supranuclear gaze palsy
Intrusive early autonomic problems; presyncope, bladder incontinence, gastroparesis

12

What are risk factors for PD?

Advancing age
Positive family history with early onset below 40yrs
Male gender
Environmental factors
Genetics

13

Which environmental factors increase the risk of developing PD?

Pesticide exposure
Prior head injury
Rural living
Beta-blocker use
Agricultural occupation
Well water drinking

14

Which environmental factors will decrease the risk of developing PD?

Smoking
Coffee drinking
NSAID use
CCB use
Alcohol consumption

15

Which gene is associated with autosomal dominant PD?

LRK2

16

Which gene is associated with autosomal recessive PD?

PARKIN

17

What drugs are used for symptomatic treatment for PD?

Levodopa (carboxylase inhibitor)
Dopamine agonists
MAO B inhibitord

18

Which drugs can be helpful for tremors?

Anticholinergic agents; trihexyphenidyl or clozapine

19

What are v common side effects of dopamine agonists and levodopa?

Nausea
Daytime somnolence
Oedema

20

What are major adverse reactions assoc with dopamine agonists?

Impulse control disorders; pathological gambling, hypersexuality, binge eating, compulsive spending
AVOID dopamine agonists in those with a history of addiction, OCS and impulsive personalities

21

What are the motor complications of long term levodopa use?

Dyskinesia
Motor fluctuations