Parkinson's

Question 1

what is alpha- synuclein responsible for?

Answer 1

Parkinson’s
Dementia with Lewy Bodies
Multi System Atrophy

Question 2

what is Tau responsible for?

Answer 2

Progressive Supranuclear Palsy

Corticobasal degeneration

Question 3

what are the fundamentals of PD?

Answer 3

clinical presentation depends on the population of neurones affected
progressive
aggregates of misfolded proteins and protein deposition

Question 4

What is the UK incidence of PD?

Answer 4

0.1-0.2% of the UK pop

roughly 145,000

Question 5

how many people does PD affect globally?

Answer 5

5 million

Question 6

what are the complications of PD?

Answer 6

motor impairment
autonomic dysfunction
cognitive impairment
sleep disturbance
GI problems
incontinence
pain

Question 7

what happens in the substania nigra (with LB)

Answer 7

severe neuronal loss

Question 8

what are the symptoms of PD?

Answer 8

resting tremor, rigidity, bradykinesia, gait disturbance, masked face, less blinking, freezing gait, micrography

Question 9

what does MRI/ CT show?

Answer 9

can show the disturbances

Question 10

what happens when there is a dopamine deficiency?

Answer 10

overactivity of indirect pathway and more GABA - excessive inhib of motor thalamus

Question 11

what are the three pharmacological options for treatment

Answer 11

L -DOPA (4x daily)
carbidopa ( inhib peripheral metabolism of levodopa)
MAO-B inhib (selegiline, rasagiline) - prvents L- DOPA removal

Question 12

what happens over long periods of time using pharmacological treatment

Answer 12

it wears off and gradually becomes more ‘off’

Question 13

what are the side effects of PD treatment?

Answer 13

dskinesia (invol movement), hedonia, impulsivity, freezing of gait

Question 14

what surgical interventions can be used to treat PD?

Answer 14

subthalamic deep brain stimulation

globus pallidus DBS

Question 15

what happens during rapid eye movement sleep disorder?

Answer 15

dream enactment
excessive daytime sleepiness
increased psych problems

Question 16

how many PD patients experience rapid eye movement sleep disorder?

Answer 16

15-35%

Question 17

what happens during autonomic disorders?

Answer 17

orthostatic hypotension

GI disturbances

Question 18

how many people are affected with autonomic disorders?

Answer 18

50-85%

Question 19

how mnay PD patients experience a lower UTI?

Answer 19

20-60%

Question 20

what are the side effects of anticholinergics?

Answer 20

‘turn off all the taps’

- dizziness, light headed, dry mouth, blurred vision, urinary retention

Question 21

what percentage of PD patients experience memory problems within 5yrs of diagnosis?

Answer 21

50%

Question 22

How common is depression among PD patients?

Answer 22

around 80%

Question 23

what types of PD are classed as atypical?

Answer 23

multi-system atrophy (MSA)
progressive supranuclear palsy
corticobasal degeneration

Question 24

what are the features of atypical PD?

Answer 24

gait dsyfunction/ postural instability
axial rigidity
no tremor
prominent autonomic dysfunction
poor response to L- DOPA
early speech problems - dysphonia

Question 25

what happens during MSA?

Answer 25

cerebellum, pons and basal ganglia are affected | alpha synuclein pathology in neurones, oligodendrocytes+ astrocytes

Question 26

how many people in the UK have MSA?

Answer 26

3000

Question 27

how many progressive supranuclear palsy cases are there in the UK?

Answer 27

4000

Question 28

what pathology does PSP and CBD have?

Answer 28

tau

Question 29

What haplotype on the MAPT locus is associated with AD, PSP and CBD?

Answer 29

Hap1C

Question 30

what are classic clinical features of PSP?

Answer 30

downward gaze (damage to oculomotor nucleus), prominent stare, backward falls, neck hyperreflexia, dsyphonia, dsyphagia

Question 31

what are the classical features of corticobasal degeneration?

Answer 31

cognitive/ memory problems, apathy, anhedonia, phantom limb, paraesthesia, myoclonus movements, rapid decline

Question 32

how many cases of CBD are there in the UK?

Answer 32

200-500 cases

Question 33

what would tilavonemab do?

Answer 33

vaccination to clear protein accumulation - stop prions in LB and prevent tau in PSP, CBD

Question 34

what is hedonia?

Answer 34

excessive happiness which can block the feeling of pain

Question 35

what year is the study assessing levodopa and the progression of parkinsons?

Answer 35

2004

Question 36

how is parkinsons characterised by?

Answer 36

the loss of pigmented dopaminergic neurones in the substania nigra

Question 37

what is levodopa?

Answer 37

replacement therapy that ameliorates the symptoms of the loss of doperminergic neurones

Question 37

what is levodopa?

Answer 37

replacement therapy that ameliorates the symptoms of the loss of doperminergic neurones

Question 38

what was previously thought about levodopa and dopamine?

Answer 38

that the reaction between the two caused a build up of ROS and then quickened residual dopamine neuronal loss

Question 39

what did levodopa show within animal studies?

Answer 39

that it is non toxic and promotes functional recovery of damaged nigral neurones

Question 40

when did levodopa get approval to be used within the UK?

Answer 40

1988

Question 41

what did the 2004 study show about levodopa?

Answer 41

there was no clinical evidence suggesting that levodopa is associated with the worsening of the condition

Question 42

what is the glial repsonse?

Answer 42

source of trophic factors, protects against ROS and glutamate by deletrious events in the ROS production

Question 43

what are trophic factors?

Answer 43

they are helper molecules that allows a neurone to make connection's

Question 44

how is glutamate linked to PD?

Answer 44

it is implicated in both motor and non-motor PD

Question 45

what happens after the death or impairment of dopamine producing cells in the substania nigra?

Answer 45

less dopamine produced - affects movement

Question 46

how many more males are affected than females in PD?

Answer 46

50% more

Question 47

how does noradrenaline link to PD?

Answer 47

due to the loss of nerve endings, there are less noradrenaline which causes fatigue and alters blood pressure

Question 48

what are the RF for PD?

Answer 48

age, toxin exposures such as pesticides, heavy metals, head injuries and being male