Parkinsonism and Movement Disorders Flashcards Preview

Neurology > Parkinsonism and Movement Disorders > Flashcards

Flashcards in Parkinsonism and Movement Disorders Deck (28):
1

what is role of basal ganglia?

involved in initiation of movements and modulation of movement

they receive input from cerebral cortex, process it and relay it back to cerebral cortex via thalamus

2

what is the most common neurodegenerative disease?

alzheimers

3

what is cause of parkinson's?

it is mostly idiopathic with some link to genetic and environmental factors

4

what is the pathological hallmark of parkinsons?

sections through brainstem reveal loss of the normally dark pigment in the substantia nigra and locus coeruleus

this pigment loss correlates with dopaminergic cell loss

5

what is a neurohistological hallmark of PD?

lewy bodies

6

what are the motor symptoms of PD?

tremor

bradykinesia

rigidity

postural instability

7

what are the non motor symptoms of PD?

sleep disorders

hallucinations

GI dysfunction

depression

cognitive impairment - dementia

constipation

anosmia

8

approx 60% loss of dopaminergic neurones results in PD - where are these neurones actually lost from?

pars compacta region of substantia nigra

9

what are the 2 broad subtypes of PD motor symptoms?

tremor dominant (with absence of other motor symptoms)

non-tremor dominant (such as akinetic-rigid syndrome)

10

what are essential features for a diagnosis of PD?

bradykinesia (unilateral onset) and one more of:

resting tremor
rigidity (cogwheel or lead-pipe)
postural instability

11

what are additional motor features which could aid diagnosis of PD?

stooped, fixed posture
dystonic postures
hypomimia ("masked face")
shuffling
short-stepped gait (+/- festination)

12

what are additional non-motor features which could aid diagnosis of PD?

late onset hyposmia
depression and anxiety
constipation
bladder problems
pain
subtle mental or cognitive impairment

13

how do you confirm PD diagnosis?

parkinsonism (features)
no alternative explanation
dopamine responsiveness

14

what should patients not present with?

early-onset bulbar problems, dementia and hallucinations, preferential involvement of lower limb
prominent eye movement disorder
intrusive early autonomic problems

15

diagnostic tests usually not needed but what could possibly be helpful?

structural brain imaging

SPECT (DaTSCAN) - normal is comma shaped. Period shape = possible PD

16

do patients with PD have increased life span?

no - decreased

17

what is risk factors for PD?

advancing age

positive family history (if <40 = probably genetic cause)

male gender

environmental factors (pesticide, head injury, rural living, b blocker use, agricultural occupation, well water drinking)

18

what environmental factors decrease risk of PD?

tobacco smoking
coffee drinking
NSAID use
CCB use
alcohol consumption

19

what is the most relevant genes in PD?

autosomal dominant = LRRK2

autosomal recessive = PARKIN

20

what drugs can be used to symptomatically treat PD by enhancing intracerebral dopamine or stimulate dopamine receptors?

levodopa
dopamine agonist
monoamine oxydase type B inhibitors
amantadine (less common)

21

when should treatment be initiated?

when symptoms cause disability or discomfort

22

what symptoms respond reliably to dopaminergic treatment early in disease?

bradykinesia and rigidity

23

tremor is inconsistently responsive to dopamine replacement - what could be more effective?

why reluctant to use these?

anticholinergic agents
trihexyphenidyl
clozapine

nasty side effects

24

what are side effects of dopamine agonist and levodopa?

nausea
daytime somnolence
oedema

25

what behaviours associated with dopamine agonist?

impulse control disorders inc pathological gambling
hypersexuality
binge eating
compulsive spending

26

when should dopamine agonists be avoided?

patients with history of addiction, obsessive-compulsive disorders and impulse personality

27

why should dopamine agonists not be prescribed in elderly?

because they are also associated with hallucination
especially shouldnt be given in those with cognitive impairment

28

what drug provides greatest symptomatic benefit?

what is longterm use of this drug associated with?

levodopa

associated with motor complications (dyskinesia and motor fluctuations)