Flashcards in Parkinson's disease Deck (31):
What causes the symptoms seen in PD? due to what pathology?
Loss of dopaminergic neurons in the substantia nigra.
Inclusion of Lewy bodies (alpha synuclein aggregates)
what can cause PD?
Mostly idiopathic although rarely can be caused by trauma (boxing), vascular problems and carbon monoxide
what is the classic triad of symptoms for PD?
decrementing bradykinesia, cog wheeling rigidity, resting tremor
How do you elicit decrementing bradykinesia?
Get patient to tap index finger and thumb quickly. Over time the movement will become smaller and smaller, before a reset. Then it would cycle through
what is the resting tremor of PD described as? how many Hz?
pill rolling (index and thumb, fingers and wrist) ~ 4 Hz
how do we test cog wheeling rigidity?
Get the patient to move one hand up and down while testing the tone of the other hand. Provides distraction and increases the cog wheeling rigidity
what are the early signs of PD?
2. Diminished arm swing when walking
3. Reduced movement in bed during sleep
4. Micrographic handwriting
what are the facial features like in a parkinsonian patient?
'Fixed' facial features and decreased blinking- due to bradykinesia of muscles of facial expression
what are some other key clinical features of PD?
Stooped, shuffling, festernating gait
Reduced arm swing
Small steps, knees slightly bent, feet slightly turned in.
Drooling- excessive salivation
Restless leg syndrome
Describe the glabeller reflex. why is it important? what sign is this?
If you repetitively tap on the forehead of a Parkinsonian patient, they will keep on blinking.
=> Myerson's sign. Sign of frontal lobe release
However a normal person will stop blinking once they normalize the sensation.
what is a ddx for resting tremor?
Resting tremor can be caused by 5 things- salbutamol, PD, cerebellar dysfunction, hypothyroidism, benign essential tremor
how do we tell the difference between resting tremor due to PD and resting tremor due to cerebellar dysfunction?
The CUP TEST:
• Should practice the cup test to distinguish PD tremor from cerebellar tremor.
• In a person with PD, the tremor disappears when the cup is given.
• In a patient with cerebellar dysfunction, the tremor will persist and the patient often spills the content of the drink.
what are some Side effects of levodopa?
Nausea, vomiting, fluctuating dyskinesia etc
Psychosis also reported
what are some side effects of MaoB inhibitors?
AF, postural hypotension
Aside from levodopa- what other drugs can we use for PD?
dopamine agonist, anticholinergics, MaoB inhibitors COMT inhibitors, amantadine
what kind of drug is apomorphine?
potent dopamine agonist
what is the fourth sign that should be added to the classic triad of PD symptoms?
postural instability, exacerbated by orthostatic hypotension
if a parkinsonian patient falls, what direction do they usually fall?
what type of neurological disease is PD?
a progressive neurodegenerative disorder.
mean age of diagnosis for PD?
70 years old
what other drug do we want to prescribe if we prescribe levodopa?
decarboxylase inhibitor like benserazide to reduce metabolism of LDOPA in periphery
risk factors for PD?
implication of tremor dominant PD?
Patients who present first with tremor generally have an indolent, slow progressive course of disease.
- generally responsive to DBS (deep brain stimulus therapy)
what is the relationship between tremor and walking in PD?
tremor is exacerbated when the patient is walking
what is the difference between dystonia and dyskinesia?
dyskinesia- complication from LDOPA therapy. Abnormal involuntary movements
dystonia- involuntary muscle contractions-- abnormal postures
what sort of ocular manifestations of PD are there?
Reduced blink rate
impaired saccades (hypometric)
how can you tell the difference between drug induced parkinsonian effects vs true PD?
drug induced- most likely bilateral rigidity and bradykinesia
true PD- usually asymmetrical
what are some urinary/bowel symptoms do PD patients have?
what is REM sleep behaviour syndrome seen commonly in PD?
PD patients act out their dreams
What anti-emetic can be prescribed for a PD patient?