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Flashcards in Parkinson's Deck (15)
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1
Q

Parkinsons disease

A

Progressive reduction of dopamine in the basal ganglia of the brain leading to disorders of movement

Characteristically asymmetrical

2
Q

Classic triad of parkinson’s disease

A

Resting tremor

Rigidity

Bradykinesia

3
Q

Pathophysiology

A

Basal ganglia are in the middle brain and responsible for coordinating habitual movements (walking, looking around, controlling voluntary movements)

Substantia nigra produces dopamine

Dopamine essential for correct functioning of basal ganglia

4
Q

Presentation

A

Unilateral tremor

Cogwheel rigidity

Bradykinesia

Depression

Sleep disturbance and insomnia

Anosmia

Postural instability

Cognitive impairment and memory problems

5
Q

Unilateral tremor

A

4-6Hz (4-6 times a second)

Pill rolling tremor

More pronounced when resting and improves on voluntary movement

Worse if distracted

6
Q

Cogwheel rigidity

A

Resistance to passive movement of a joint (little jerks)

7
Q

Bradykinesia

A

Handwriting gets smaller

Shuffling gait

Difficulty initiating movement (standing still to walking)

Difficulty turning round (lots of little steps)

Hypomimia

8
Q

Multiple system atrophy

A

Neurones of multiple systems in the brain degenerate

Degeneration of basal ganglia leads to Parkinson’s presentation

Degeneration of other areas leads to autonomic dysfunction (postural hypotension, constipation, abnormal sweating, sexual dysfunction)

Cerebellar dysfunction (causes ataxia)

9
Q

Dementia with Lewy Bodies

A

Progressive cognitive decline

Symptoms of visual hallucinations, delusions, disorders of REM sleep and fluctuating consciousness

Features of Parkinsonism

10
Q

Diagnosis

A

Clinical based on symptoms and examination

UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria

11
Q

Lveodopa

A

Synthetic dopamine

Most effective treatment for symptoms but becomes less effective over time

Main side effect is dyskinesias when dose too high

12
Q

Dyskinesias

A

Dystonia: excessive muscle contraction leads to abnormal postures or exaggerated movements

Chorea: abnormal involuntary movements that can be jerking and random

Athetosis: involuntary twisting or writhing movements usually in fingers, hands or feet

13
Q

First line treatments

A

If motor symptoms affecting patients quality of life: levodopa

If not affecting quality of life: dopamine agonist, levodopa or monoamine oxidase B inhibitor

14
Q

Dopamine agonists

A

Stimulate dopamine receptors

Less effective than levodopa in reducing symptoms

Side effect: pulmonary fibrosis

e.g. bromocryptine, pergolide, cabergoline

15
Q

Monoamine oxidase B inhibitors

A

Stops the breakdown of dopamine, serotonin and adrenaline

e.g. selegiline, rasagiline