Parkinson Disease

Question 1

what is the most common cause of parkinsonism?

Answer 1

idiopathic (parkinson disease)

Question 2

what are the 2 parts of pathogenesis of Parkinson Disease?

Answer 2

presence of lewy bodies
neuronal degeneration

Question 3

what is the characteristic pathogenesis of Parkinson disease?

Answer 3

degeneration of dopaminergic nigrostriatal system

Question 4

what is the age of onset?

Answer 4

45-65 years old

Question 5

what are 4 risk factors?

Answer 5

family history
male
herbicide/pesticide exposure
PMH of head trauma

Question 6

what are the 4 cardinal symptoms?

Answer 6

resting tremor
bradykinesia
rigidity
postural instability

Question 7

how do the symptoms progress?

Answer 7

start in one limb and spread to the other limb on the same side

Question 8

what are 5 facial symptoms that can be present?

Answer 8

immobile
wide palpebral fissures
infrequent blinking
scalp/face seborrhea
soft voice

Question 9

what will 78% of patients with Parkinson disease have? (2)

Answer 9

cognitive dysfunction
dementia

Question 10

tapping between eyebrows causing patient to blink continuously

Answer 10

myerson sign

Question 11

what must be present to make a clinical diagnosis of Parkinson disease? (2)

Answer 11

bradykinesia + tremor OR rigidity

Question 12

what diagnostic can be used to exclude structural lesions?

Answer 12

brain MRI

Question 13

what diagnostic is recommended if diagnosis is in doubt?

Answer 13

challenge test with carbidopa-levodopa OR apomorphine

Question 14

what patient is diagnosed with Parkinson disease after the challenge test?

Answer 14

if patient improves

Question 15

what is the gold standard diagnostic?

Answer 15

neuropathological exam at autopsy

Question 16

what 2 medications may slow disease progression so can be started early or in young patients?

Answer 16

dopaminergic agents

rasagiline
selegiline

Question 17

what medication can improve dyskinesias from chronic levodopa therapy and helps patients with mild symptoms by increasing the dopamine release or blocking dopamine uptake?

Answer 17

amantadine

Question 18

which (2) medications have similar mild SE as levodopa and are effective in early or advanced parkinson disease?

Answer 18

dopamine agonists:

pramipexole
ropinirole

Question 19

in which patients may parkinson disease progress more quickly? (2)

Answer 19

older when symptoms begin
no tremor

Question 20

what is the prognosis of parkinson disease? (2)

Answer 20

reduces longevity
can lead to incapacity within 10-20 years