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Neurology > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What is Parkinson’s Disease?

A
  • A chronic, progressive neurodegenerative condition
  • Occurs secondary to loss of dopaminergic neurones within the substantia nigra
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2
Q

What is the Triad for Parkinsonism?:

A
  • Resting Tremor
  • Rigidity
  • Bradykinesia
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3
Q

What is the Anatomy affected in Parkinson’s Disease?

A
  • The basal ganglia are collections of nuclei found in the subcortical white matter of the brain
  • The thalamus forms extensive connections with the nuclei
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4
Q

What is the Physiology behind Parkinson’s Disease?

A
  • The basal ganglia have a number of important roles in movement generation
  • They help to kick start and fine tune movement initiated by the motor cortex in a coordinated manner
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5
Q

What are some of the important functions of the basal ganglia?

A
  • Inhibition of muscle tone
  • Co-ordinated, slow, sustained movement
  • Suppression of useless patterns of movement
  • Initiation of movement
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6
Q

What is the causes of Parkinson’s Disease?

A
  • Largely idiopathic
  • Attributed to a monogenic cause
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7
Q

How many neurones need to be affected to be able to see the symptoms of Parkinson’s Disease?

A
  • A substantial number of neurones (50-80%) need to have been lost within the substantia nigra
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8
Q

What do the basal ganglia modulate?

A
  • The basal ganglia are essential for the modulation of pyramidal motor output to allow normal movement
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9
Q

What are the two pathways that the basal ganglia modulate for normal movement?

A
  • Direct and Indirect
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10
Q

What is the pathophysiology behind the direct pathway?

A
  • The direct pathway is mostly a stimulatory pathway associated with D1 receptors
  • The dopamine released from the substantia nigra via dopaminergic neurones is able to activate the direct pathway and generate movement
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11
Q

What is the pathophysiology behind the indirect pathway?

A
  • The indirect pathway is mostly an inhibitory pathway associated with D2 receptors
  • Activation of the indirect pathway is essential in the inhibition of muscular tone to prevent unnecessary movement
  • Dopamine that is released from the substantia nigra is able to inhibit the indirect pathway via D2 receptors leading to the generation of movement
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12
Q

What are some of the clinical features associated with Bradykinesia?

A
  • A general slowing of voluntary movements
  • Reduced arm swing
  • Reduction in the amplitude with repetitive movements
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13
Q

What are the some of the clinical features associated with Tremor?

A
  • Pill- rolling tremor
  • 4-6 Hz
  • Induced by distraction
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14
Q

What are some of the clinical features associated with Rigidity?

A
  • Increase resistance to passive movement
  • Cogwheel due to superimposed tremor
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15
Q

What are some of the Other features regarding Parkinson’s?

A
  • Expressionless face (Parkinsonian Mark)
  • Micrographia - small writing
  • Soft Voice
  • Drooling of Saliva
  • Shuffling Gait
  • Glabellar tap - repeated tapping of forehead associated with persistent blinking
  • Depression
  • Bowel and Bladder Symptoms
  • Sleep Disorders
  • Sexual Dysfunction
  • LUTS
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16
Q

How many steps are there for the diagnosis of Parkinson’s Disease?

A
  • 3
17
Q

What is Step 1 in the diagnosis of Parkinson’s Disease?

A
  • Bradykinesia and one of the following:
    1. Muscular rigidity
    2. Postural instability
    3. Resting tremor (4-6 Hz)
18
Q

What is Step 2 in the diagnosis of Parkinson’s Disease?

A

The exclusion criteria for Parkinson’s Disease:
- Repeated strokes
- History of Trauma
- Definite Encephalitis
- Sustained remission
- Unilateral features after 3 years
- Antipsychotic/ dopamine- depleting drugs
- Cerebral tumour
- Atypical neurological features
- Negative response to Levodopa

19
Q

What is Step 3 in the diagnosis of Parkinson’s Disease?

A

Supportive criteria of Parkinson’s Disease:
- Progressive disorder
- Unilateral onset
- Resting tremor
- Persistent asymmetry
- Excellent response to levodopa
- Severe levodopa response, greater than and equal to 5 years
- Clinical course of greater than and equal to 10 years

20
Q

What is the MDS diagnostic criteria?

A
    1. Confirmation of Parkinsonism ( bradykinesia + tremor/ rigidity)
    1. No absolute exclusion criteria present
    1. Greater than or equal to 2 supportive criteria
    1. Absence of red flags
21
Q

What are the 4 broad causes of Parkinsonism?

A
  • Parkinson’s disease
  • Parkinson-plus syndromes
  • Drug-induced
  • Other pathology (post-encephalitis, tumour, vascular)
22
Q

What are the Parkinson- Plus Syndromes?

A
  • Multi-System Atrophy (MSA)
  • Progressive Supranuclear Palsy (PSP)
  • Dementia with Lewy-Body (DLB)
  • Corticobasal Degeneration (CBD)
23
Q

What are the investigations for Parkinson’s?

A
  • Neuroimaging (CT/MRI)
  • PET scanning with fluorodopa - helps localise dopamine deficiency in the basal ganglia
  • Striatal dopamine transporter imaging using 123 I-FP-CIT (differentiate Parkinsonism from essential tremor)
24
Q

What is the Managment for Parkinson’s Disease?

A
  • Levodopa with a DOPA decarboxylase inhibitor (this stops the peripheral break down of levodopa to dopamine)
  • Dopamine Agonists
    -MAO- B inhibitors
  • COMT inhibitors
  • anti-muscarinic
  • Apomorphine - non-selective dopamine agonist (advanced disease) - given via subcutaneous injection/infusion
25
Q

What is the surgical management of Parkinson’s?

A
  • Thalamic or subthalamic surgery
26
Q

What are the motor complications of Parkinson’s?

A
  • Motor on-off fluctuations: switch from dyskinesia to immobility in a few minutes
  • Dyskinesia: hyperkinetic movement due to dosing of medications
  • Freezing of gait: complete inability to move
  • Wearing off phenomenon - towards the end of dose
  • Falls
27
Q

What are the non-motor complications of Parkinson’s?

A
  • Aspiration Pneumonia
  • Nutritional deficiency, dysphasia and weight loss
  • Bladder, bowel and sexual dysfunction
  • Pressure sores
  • Sleep disorders
  • Dementia and depression
  • Postural hypotension
  • Impulse Control disorders and psychosis

Neurology (18 decks)

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