Flashcards in Parksinsons Deck (68)
1
Age of presentation of Parkinson’s ?
45-60
2
Parkinsonism triad?
Bradykinesia, tremor, rigidity. Usually bilateral but can start unilateral
3
What happens to tremor in Parkinson’s ?
Disappears with activity
4
What is rigidity?
Increased resistance to passive movement
5
What is rigidity like throughout the range of movement ?
Equal throughout
6
Gait in Parkinson’s ?
Show, shuffling gait
7
Arms and posture during walking ?
Stopped posture and reduced arm swing
8
What is speech like ?
may be slow and monotonous. In late stage disease may be slurred, or even lost
9
Power and sensory loss?
Power remains normal and there is no sensory loss
10
What other psychiatric conditions associated with Parkinson’s ?
Dementia and depression
11
Why do you get hallucinations.
A combination of the disease and the drugs used. Often they are not unpleasant
12
What are kayser fleisher rings seen in?
Wilson’s disease (copper)
13
Which drugs can cause Parkinsonism?
Drugs (usually dopamine antagonsists)–e.g. prochlorperazine, metoclopramide (antiemetics) phenozanthines, butyrophenones (neuroleptics)
14
pathological hallmark of parkinsons disease
prominent dopaminergic neurone loss in the substantial nigra with alphasyneuclein containing lewey bodies and lewey neurites
15
which part of the brain is the substantial nigra found?
basal ganglia
16
what are upper motor neurone features?
pyramidal weakness and spasticity
17
triad of parkinsonianism?
bradykinesia, resting tremor and rigidity
18
Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance?
chorea
19
what does PD present with?
PD presents with tremor, muscular rigidity, akinesia, rest tremor, and gait and postural impairment
20
which subtype has the slower rate of progression ?
tremor dominant
21
non motor features of PD?
olfactory dysfunction, cognitive impairment, psychiatric symptoms, sleep disorders, autonomic dysfuncLon, pain, and faLgue.
22
when does diagnosis occur in PD?
with the onset of motor symptoms
23
what is progression of PD characterised by?
progression of motor symptoms
24
Neuronal loss in PD occurs in many other regions including?
ocus ceruleus, nucleus basalis Meynert, pedunculoponLne and raphe nuclei, dorsal motor nucleus of vagus, amygdala, hyopthalamus
25
how are lewey bodies formed?
Misfolded α-synuclein,which is insoluble and aggreagated, forms intracellular inclusions (Lewy bodies)
26
Prolonged muscle spasms and abnormal postures
dystonia
27
Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance
chorea
28
a parasomnia characterized by abnormal or disrupLve behaviours (such as talking, laughing, shouLng, gesturing, grabbing, punching, kicking,, sirng up in bed)
Rapid eye movement sleep behaviour
29
treatment of rapid eye movement sleep disorder?
clonazepam or malatonin
30
what is the frequency of the rest tremor in parkinsons?
4-6Hz
31
where are lewey bodies found in parkinsons?
not confined to the brain, they are also present in spinal cord and peripheral nervous system
32
what are lewey bodies?
misfolded alpha sinuclein, which is insoluble and aggregated. These form intracellular inclusions
33
what does pigment loss correlate with?
dopaminergic cell loss
34
greatest risk factor of parkinsons?
age
35
male to female?
more common in males
36
greatest genetic risk factor for PD
mutations in GBA
37
what is treatment in PD aimed at doing ?
enhancing intracerebral dopamine concentrations or stimulate dopamine receptors
38
which drug class associated with oedema?
dopamine agonists
39
which drug associated with dyskinesia? (writhing movements)
levodopa
40
what is the "on-off effect" of levodopa
alterations between periods of good motor symptom control and periods of reduced motor symptom control
41
PsyChosis in PD is most efficiently managed with
Clozapine
42
motor symptoms in PD?
bradykinesia
rest tremor
rigidity
postural and gait impairment (stooped posture and show, shuffling gait with reduced arm swing)
43
Slowness of movement with progressive loss of amplitude or speed during aWempted rapid alternaLng movement of body segments
BRADYKINESIA
44
how can you assess bradykinesia?
can be assessed by asking the patient to perform some repetitive movements as quickly and wisely as possible
45
decreased facial expression and eye blinking ?
hypomimia
46
what happens to rhythmic oscillatory tremor on voluntary active movement
disappears
47
what is re emerging tremor?
tremor reappears after hands held out
48
is head tremor typical for PD?
no
49
what is cog wheel rigidity
"Cogwheel" rigidity occurs when there is also a tremor and is characterized by a "stop and go" effect during a range of motion maneuver. Felt especially at the wrist
50
why do you get a stooped posture?
impaired postural reflexes
51
what is the parkinsonian gait like ?
slow, shuffling gait with a narrow base
52
what is hyposmia?
reduced ability to smell (hypnosemia)
53
what are premotor symptoms to ask about?
REM sleep behaviour, loss of smell, constipation
54
exposure to what can be a risk factor for parkinsons?
manganese, pesticides
55
do you get dementia early in the disease course?
no
56
investigations for parkinsons?
structural brain imaging
possibly structural brain imaging
dopamine functional imaging is unable to distnguish PD from other causes of degeneratve Parkinsonism, but should be normal in essenLal tremor, dystonic tremor, psychogenic parkinsonism.
positive levodopa challenge
genetic testing where appropriate
57
what is vascular parkinsonism?
parkinsonism affects mainly the lower limbs. rest tremor is uncommon. get a poor levodopa response
58
does parkinsonism tend to be symmetrical or assymetrical?
symmetrical, although can start unilateral
59
what drugs can cause parkinsonism?
any drugs that block the action of dopamine (especially neuroleptic drugs)
60
what improves essential tremor?
alcohol and beta blockers
61
frequency of essential tremor?
higher frequency (12Hz)
62
inheritnace pattern of essential tremor?
autosomal dominant
63
typical onset of essential tremor?
15 years
64
common cause of degenerative parkinsonism, hot cross bun sign on MRI?
multi system atrophy O+
65
Symmetric akineLc-rigid syndrome with predominantly axial involvement. Vertical gaze supra nuclear palsy?
progressive supranuclear palsy
66
Core symptoms include cerebellar gait ataxia, postural / intenLon tremor, variably Parkinsonism, dysautonomia, cogniLve decline of frontal type, and peripheral neuropathy
fragile x tremor ataxia syndrome
67
useful for managing tremor in drug induced parkinsonism?
procyclidine
68