Parkinson's Flashcards
(22 cards)
What is Idiopathic Parkinson’s disease (PD)?
- Neurodegenerative disorder
- Cardinal features:
- Resting tremor, rigidity, bradykinesia, postural instability
- +/- non-motor symptoms
Epidemiology of PD?
- Prevalence of disease increases with age
- Mean age of onset is 65 years
Aetiology of PD?
- Loss of dopaminergic neurons in the substantia nigra
- Lewy bodies in the basal ganglia, brainstem and cortex
- Most cases are sporadic, but genetic loci have been identified in familial cases:
- eg genes coding for alpha synuclein, PINK-1, parkin
Classification of PD?
- Age of onset
- Juvenile parkinsonism: under 21 years
- Young-onset parkinsonism: 21 to 40 years
- PD: 40+ years
What is the extrapyrimidal triad of Parkinsonism?
- Tremor
- Worse at rest, pill rolling
- Hypertonia
- Rigitiy + tremor gives cogwheel rigidity
- Felt by examiner during pronation and supination
- Bradykinesia
- Slow to intiate movement
- Shuffling, leaning forward gait - Marche a petit pas
- Micrographia
Clinical features of Parkinsons?
- Parkinsonian triad
- Non-motor symptoms:
- Autonomic dysfuction: postural hypotension, constipation
- Sleep disturbance
- Reduced sense of smell
- Depression, dementia, psychosis
Describe the diagnosis of PD?
- Clinical
- Based on bradykinasia with resting tremor and/or hypertonia
- Cerebellar disease and frontotemporal dementia should be excluded
- Clinical response to dopaminergic therapy
- If signs are NOT worse on one side, look for another cause:
- MRI for structural pathology
Risk factors for PD?
- Increasing age
- History of familial PD in younger-onset disease
- Mutation in gene encoding glucocerebrosidase
- MPTP exposure
What is the first test to order for a patient with suspected PD?
- Dopaminergic agent trial
- Should be improvement in symptoms in PD
What other tests should be considered in a patient with suspected PD?
- MRI brain
- May show other causes: trauma, stroke
- Fluorodopa PET
- Decreased basal ganglia dopamine uptake
- Olfactory testing
- Hyposmia or anosmia
- Genetic testing
Name some differentials for PD?
- Progressive supranuclear palsy (PSP)
- Midbrain atrophy on MRI supportive of PSP
- Lewy body dementia
- Neuropsychometric testing may distinguish cognitive defect domains
- Drug-induced parkinsonsim
- History of specific drug usage
What drugs can cause drug-induced parkinsonism?
- Lithium
- Neuroleptic
- Metoclopramide
- Calcium channel blocker
Describe the treatment for mild parkinsonism?
Describe the treatment for moderate parkinsonism?
Describe the treatment for advanced parkinsonism?
Examples of monoamine oxidase-B (MAO-B) inhibitors?
- Rasagiline
- Selegiline
Examples of dopamine agonists?
- Ropinorole
- Rotigotine
- Pramipexole
Describe the use of Levadopa for PD?
- Dopamine precursor
- Combined with dopa-decarboxylase inhibitor
- SEs: dyskinesia, painful dystonia, psychosis, N/V
- Give domperidone for N/V
Describe the use of dopamine agonists in PD?
- Can delay starting levadopa in early PD
- Allow lower doses of levadopa as disease progresses
- SEs: drowsiness, nausea, hallucinations, compulsive behavioue
Describe the use of MAO-B inhibitors in PD?
- Alternatice to dopamine agonists in early PD
- SEs: postural hypotension, AF
Describe the use of COMTinhibitors in PD?
- May help with motor complications in late disease
- Requires monitoring of LFTs
Examples of COMT inhibitors?
- Entacapone
- Tollecapone
