Flashcards in Parkinson's disease Deck (21)
What are symptoms of hyperkinetic movement disorders?
What are the cardinal motor symptoms of PD?
Slowness of movement
Stiffness/ rigidity - bradykinesia
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
What non-motor symptoms are assoc with PD?
Sleep disorders; REM behavioural disorder
GI disturbances; constipation
Does parkinson's just affect the basal ganglia?
No - lewy bodies can be seen across the whole cortex
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
Which subtype of PD has a better prognosis?
Tremor dominant; slower rate of progression and less functional disability
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
What are some additional motor symptoms of PD that are not included in the diagnostic criteria?
Stooped, fixed posture
Short stepped gait
What 3 things are required for a confirmation of PD?
No alternative explanation
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
What are risk factors for PD?
Positive family history with early onset below 40yrs
Which environmental factors increase the risk of developing PD?
Prior head injury
Well water drinking
Which environmental factors will decrease the risk of developing PD?
Which gene is associated with autosomal dominant PD?
Which gene is associated with autosomal recessive PD?
What drugs are used for symptomatic treatment for PD?
Levodopa (carboxylase inhibitor)
MAO B inhibitord
Which drugs can be helpful for tremors?
Anticholinergic agents; trihexyphenidyl or clozapine
What are v common side effects of dopamine agonists and levodopa?
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