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Flashcards in FN: Parkinsons Disease Deck (20):
1

Epidemiology

􏰀 Mean onset 65yrs
􏰀 2% prevalence

2

Pathophysiology

􏰀 Destruction of dopaminergic neurones in pars compacta
of substantia nigra.
􏰀 β-amyloid plaques
􏰀 Neurofibrillary tangles: hyperphosphorlated tau

3

Features: TRAPPS PD

􏰀 Asymmetric onset: side of onset remains worst
􏰀 Tremor: ↑ by stress, ↓ by sleep
􏰀 Rigidity: lead-pipe, cog-wheel
􏰀 Akinesia: slow initiation, difficulty ̄c repetitive movement,
micrographia, monotonous voice, mask-like face
􏰀 Postural instability: stooped gait ̄c festination
􏰀 Postural hypotension: + other autonomic dysfunction
􏰀 Sleep disorders: insomnia, EDS, OSA, RBD
􏰀 Psychosis: esp. visual hallucinations
􏰀 Depression / Dementia / Drug SEs

4

Sleep Disorder

􏰀 Affects ~90% of PD pts.
􏰀 Insomnia + frequent waking → EDS
􏰂 Inability to turn
􏰂 Restless legs
􏰂 Early morning dystonia (drugs wearing off) 􏰂 Nocturia
􏰂 OSA
􏰀 REM Behavioural sleep Disorder
􏰂 Loss of muscle atonia during REM sleep 􏰂 Violent enactment of dreams
􏰀 Da SEs: insomnia, drowsiness, EDS

5


Autonomic Dysfunction

􏰀 Combined effects of drugs and neurodegeneration
􏰀 Postural hypotension
􏰀 Constipation
􏰀 Hypersalivation → dribbling (↓ ability to swallow saliva)
􏰀 Urgency, frequency, Nocturia
􏰀 ED
􏰀 Hyperhidrosis

6

L-DOPA SEs: DOPAMINE

􏰀 Dyskinesia
􏰀 On-Off phenomena = Motor fluctuations
􏰀 Psychosis
􏰀 ABP↓
􏰀 Mouth dryness
􏰀 Insomnia
􏰀 N/V
􏰀 EDS (excessive daytime sleepiness)

7

Motor Fluctuations

􏰀 End-of-dose: deterioration as dose wears off ̄c
progressively shorter benefit.
􏰀 On-Off effect: unpredictable fluctuations in motor
performance unrelated to timing of dose.

8

Ix

DaTSCAN

9

Mx

􏰀 MDT: neurologist, PD nurse, physio, OT, social worker, GP and carers
􏰀 Assess disability
􏰂 e.g. UPDRS: Unified Parkinson’s Disease Rating Scale
􏰀 Physiotherapy: postural exercises 􏰀 Depression screening

10

Mx for young onset ± biologically fit

Young onset ± biologically fit
1. Da agonists: ropinirole, pramipexole
2. MOA-B inhibitors: rasagiline, selegiline 3. L-DOPA: co-careldopa or co-beneldopa

11

􏰀 Biologically frail ± comorbidities Mx

1. L-DOPA
2. MOA-B inhibitors

12

􏰀 Other therapies

COMT inhibitor
Apomorphine
Amantiine
Atypical antipyschotices
SSRIs

13

COMt inhibitor

tolcapone, entacapone
􏰄 Lessen end-of-dose effect

14

Apomorphine:

potent Da agonist
􏰄 SC rescue pen for sudden “off” freezing

15

Amantidine:

weak Da agonist
􏰄 Rx of drug-induced dyskinesias

16

Atypical antipyschotics

: e.g. quetiapine
Surgical
􏰄 Disease-induced psychosis

17

SSRIS

citalopram sertraline for depression

18

Surigcal

interpret basal ganglia
Deep brain stimulation

19

Prognosis

􏰀 ↑ mortality
􏰀 Loss of response to L-DOPA w/i 2-5yrs

20


Differential


􏰀 Parkinson plus syndromes 􏰀 Multiple infarcts
􏰀 Drugs: neuroleptics
􏰀 Inherited: Wilson’s
􏰀 Infection: HIV, syphilis, CJD 􏰀 Dementia pugilistica

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