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Elderly YR3 > Parkinson's Lecture > Flashcards

Parkinson's Lecture Flashcards

1
Q

What is Parkinsons?

A
  • Loss of dopaminergic neurones in substantia nigra of basal ganglia
  • = triad of bradykinesia, tremor and rigidity
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2
Q

Cause of loss of dopaminergic neurones in parkinsons

A

Alpha synuclein misfolds = deposits and forms Lewy bodies

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3
Q

Theories surrounding Parkinsons

A
  • Link to pesticides (farmers?)
  • Age genetics and environment interplay
  • Start in gut? Constipation occurs before motor symptoms?
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4
Q

How much dopaminergic neruones do you have to lose before becoming symptomatic?

A

50% - LOTS it is a very slow onset disease

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5
Q

Ways to visualise brain to show parkinsons

A

DAT scan
* radioactive tracer attaches to dopamine transporters
* These are present on dopaminergic neurones
* Shows presence of these
* Reduced signalling comes from striatum in parkinsons
* Usually asymmetric reduction and eventually symmetric

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6
Q

Manifestations of bradykinesia

A
  • Short shuffling steps
  • Reduced arm swing
  • Difficulty initiating movement
  • When asked to finger tap index and thumb = decreased amplitude and irregular rhythm
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7
Q

Tremor in Parkinsons

A
  • Not present in all - 70%
  • Most marked at rest
  • Starts unilaterally –> bilaterally
  • 3-5Hz
  • Pill-rolling between thumb and index finger
  • Worse when stressed
  • Improves with voluntary movement
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8
Q

rigidity in parkinsons

A
  • Lead pipe
  • Cogwheel if tremor present sometimes
  • Difficulty turning, transferring and fine motor movement
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9
Q

Other manifestations of Parkinsons

A
  • Hypomimia - loss of facial expression
  • Flexed posture
  • Micrographia
  • Drooling
  • Depression - or other psychiatric features
  • Anosmia
  • REM sleep disorder - acting out dreams
  • Fatigue
  • Autonomic dysfunction - postural hypotension
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10
Q

What does Parkinsons increase risk of?

A

Falls
Hip fracture from fall
Osteoporosis - decreased mobility

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11
Q

Tip for examining PD patients

A

Distract while examining to get them to fully relax to assess tone eg get them to do something with other hand or count back from 20

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12
Q

What can trigger freezing?

A

Walking through doors
Change of flooring

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13
Q

Scale for assessing severity of Parkinsons

A

Hoehn and Yahr Scale

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14
Q

Other way of staging severity of Parkinsons

A
  • Early
  • Maintenance
  • Advanced/complex - PD drugs become less effective, increased doses needed, cognitive changes
  • Palliative
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15
Q

Causes of Parkinsonism

A
  • Parkinsons
  • Parkinson plus syndromes
  • Drugs
  • Other - post encephalitis, tumour, vascular
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16
Q

Parkinson plus syndromes

A
  • MSA - multi system atrophy
  • PSP - Progressive supranuclear palsy
  • CBD - Corticobasal degeneration
  • LBD - lewy body dementia
17
Q

Drugs that can cause Parkinsonism

A
  • Antipsychotics - Haloperidol
  • Anti-emetics - Metoclopromide, prochlorperazine
  • Lithium
  • Methyldopa
18
Q

What is progressive supranuclear palsy?

A
  • Postural instability and falls
  • Impairment of vertical gaze bilaterally (down gaze worse than up)
  • Parkinsonism
  • Cognitive impairment
  • Dysarthria too

Caused by midbrain atrophy - MRI sign is hummingbird

19
Q

Problem with parkinson plus syndromes

A
  • Poor response to medication
  • Poorer prognosis for pt vs parkinsons
  • Need to identify
20
Q

What is multisystem atrophy?

A
  • Severe autonomic dysfunction
  • Severe postural hypotension
  • Urogenital dysfunction (eg erectile dysfunction, atonic bladder)
21
Q

What is lewy body dementia?

A
  • Parkinsonism and dementia symptoms occur within 1yr of eachother
  • Hallucinations of children and animals
  • Contrast - In Parkinsons disease cognitive decline will occur at least 1 yr after motor symptoms
22
Q

What is corticobasal degeneration?

A
  • Dementia
  • Parkinsonism
  • Limb apraxia - difficulty with motor planning, can lead to alien limb syndrome when they feel limb is not being moved by them
23
Q

Diagnosis of Parkinsons

A

Mainly clinical
If worried about other causes - CT for masses
MRI for PPS
PET
DAT scan

24
Q

Things to look out for in someone with Parkinsons acute presentation of worsening

A
  • Medication SEs
  • Constipation - affects absorption of medication
  • Get it on time - campaign for Parkinson meds to be on time
  • New medicattions
  • Stress/anxiety
  • Infections underlying
25
Q

First line treatment of Parkinsons

A
  • Affecting QOL - Levodopa
  • Not affecting QOL - dopamine agonists, levodopa or monoamine oxidase B inhibitors
26
Q

Revise drugs for parkinsons in lecture given in Yr 2 pharmacology/neuro

A

:)

27
Q

Surgical management of PD

A

Deep brain stimulation - works well if tremor dominant, quite high risk of stroke/death though, done in under 70s, not for cognitive impaired, stays in brain stimulating continiously.
Knocks 10yrs off symptoms

28
Q

Complications of Parkinsons

A
  • Falls
  • On/off
  • Freezing gair
  • Wearing off medication
  • Dyskinesia
  • Impulse disorders
  • Aspiration pneumonia
29
Q

Interesting thing about Parkinsons

A

There is a woman who can smell Parkinsons - theory that increases high molecular weight lipids active could give the smell from skin

30
Q
A

Elderly YR3 (14 decks)

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