Flashcards in Parkinson's Disease Deck (90)
What are the four cardinal features of Parkinson's disease?
What is the initial complaint in most parkinson's patients?
Is the tremor with Parkinson's disease a resting or intention tremor? does it usually onset as a unilateral or bilateral tremor?
True or false: most patients with tremors are usually from Parkinson's
Very false--many patients are idiopathic
What happens to all tremors with sleeping, including parkinson's?
What is usually the most disabling feature of Parkinson's disease?
What is the cause of the freezing with Parkinson's disease?
What happens to the speech with Parkinson's? What is the simple technique that can be used to decrease this?
Sing in the shower
What is the rigidity like with Parkinson's disease?
Resistance to PROM "cogwheel" component (feels like a ratchet d/t tremor imposed on rigidity)
What is antepulsion and retropulsion with Parkinson's?
Inability to stop once moving in forward/backward direction, or make rapid adjustments in posture
What are the three major autonomic dysfunctions with Parkinson's?
What percent of Parkinson's patients have dementia?
True or false: If you have dementia within a year of onset with parkinson's, you most likely do not have Parkinson's, but some other disease
Mask-like facies = what disease?
What is the classic Parkinsonian posture?
What, besides dementia, are the cognitive effects of Parkinson's?
What generally happens to sleep with Parkinson's?
What is the pathophysiology of Parkinson's disease?
Degeneration of basal ganglia--specifically the zona compacta of the substantia nigra
What happens to the substantia nigra with Parkinson's?
Loss of it d/t loss of dopaminergic neurons
What are Lewy bodies? Where are they particularly found?
Alpha synuclein eosinophilic inclusion
What sense is lost particularly early with Parkinson's? Why?
Smell d/t loss of olfactory neurons
What is the protein that is stained for with Parkinson's, to locate Lewy bodies? What is the role of this in PD?
Ubiquitin--may be toxic to brain
True or false: Parkinson's is a cortical dysfunction?
What is the cortical input to the caudate nucleus?
Feeds through the putamen, globus pallidus, and thalamus...BACK TO CORTEX
What are the components of the striatum? What is its major function?
What is the neurotransmitter used within the BG?
What is the area of the brain that turns off the BG? What is the neurotransmitter here?
What parts of movement do the BG control?
Initiation and termination
What is problem with Huntington's disease?
Loss of the caudate nucleus
What are the degenerative diseases that can manifest like Parkinson's disease?
What is hypoxemic Parkinsonism?
Hypoxia of the substantia nigra leads to a PD like state
What is the major drug class that can cause Parkinsonism?
-Dopamine receptor blockers (e.g. antipsychotics, haloperidol, thorazine, Li)
What is the GI motility drug that can induce Parkinsonism?
What is the antiemetic drug that can induce Parkinsonism?
What is the anticonvulsant drug that can induce Parkinsonism?
What are the two antiHTN drugs that may cause Parkinson's?
What metal can cause Parkinsonism?
What is the gaseous toxin that can cause Parkinsonism?
What are the liquid toxins that can cause Parkinson-like Disease?
What is the narcotic drug that can cause Parkinson-like disease?
MPTP (methyl-phenyl tetrahydropyridine)
What is the MOA of selegiline? Use?
-Used in combination with L-DOPA to decrease the breakdown of L-DOPA
What is normal pressure hydrocephalus? S/sx (classic triad)?
-Failure of reabsorption of CSF causes increased volume of the ventricles
-Lethargy, gait disorder, and urinary incontinence
What is the classic triad of s/sx with NPH?
-Incontinence of urine
What are the three inclusion criteria for PD? How many are needed?
What are the 5 supportive criteria for PD?
-Excellent response to L-DOPA
-Clinical course over 10 years
True or false: you do not make a diagnosis based on response to treatment
True or false: multiple strokes or head trauma are exclusion criteria for PD
Unilateral disease lasting longer than how long is a PD exclusion criteria?
What are the oculomotor manifestations that is an exclusion criteria for PD?
-Supra-nuclear gaze palsy
True or false: PD should never have cerebellar signs
True or false: early autonomic dysfunction is common with PD
True or false: MPTP exposure is an exclusion criteria for PD
Which gender is usually affected more with PD?
What percent of PD is familial? What are the possible other causes?
-Oxidative stress and environmental risk factors
What are the two protective factors against PD?
What are the two putative factors for PD?
How do you diagnose PD?
H and P
What may an MRI show with parkinson's?
May show hypodensity Fe++ in the basal ganglia
What are the four major medications that are used to treat Parkinson's?
What is the classic anticholinergic drug used to treat PD?
What are the three major dopaminergic drugs used to treat PD?
What are the COMT inhibitors that are used in conjunction with L-DOPA? Which acts centrally, and which acts peripherally?
What are the two major MAO-B inhibitors used in the treatment of PD?
What are the surgical options for PD?
What is the role of the deep brain stimulator in the treatment of PD?
Turn off the overactive BG using HV/LA (high voltage, low-amplitude)
What is the role of supplemental neuroprotective agents used to prevent PD?
Do not work
What is the role of PT in the treatment of PD?
Can be equal to L-DOPA effect
What is the problem with L-DOPA with absorption in the GI tract?
Competes with other amino acids
What are the three neurotransmitters that are affected in Parkinson's disease, and how are they affected?
Mutations in the gene encoding what enzyme is associated with an increased risk of developing Parkinson's disease (hint: same as in Gaucher's disease)?
Dopamine released from the substantia nigra act on what part of the brain?
What are the three major sequence processes that occur in the pathophysiology of Parkinson's disease?
1. D1 neurons no longer inhibit the internal segment of the globus pallidus
2. Increased release of GABA from the pallidus to the thalamus
3. Increased GABA to the thalamus leads to inhibition of movement
What are the 5 drugs used to treat Parkinson's?
What is the MOA of bromocriptine?
Dopamine receptor agonist
What is the MOA of pramipexole?
Dopamine receptor agonist
What is the MOA of ropinirole?
Dopamine receptor agonist
What is the MOA of amantadine in the treatment of parkinson's?
NMDA receptor antagonist causes an increased release of dopamine and decreased reuptake
What is the MOA of carbidopa?
What is the MOA of selegiline?
MAOI B inhibitor used to decrease the breakdown of L-DOPA
Is there weakness with PD?
Not usually, but low level of functioning may seem like it.
What is the role of the caudate nucleus?
Input region of the BG, along with the putamen
What are the components of the basal ganglia? (5)
What are the components of the striatum?
Caudate nucleus and putamen
What is the effect of the substantia nigra on the striatum? How? What happens to this with PD?
Inhibits it though dopaminergic projections
Loss of inhibition of the BG leads to inability to move well
True or false: dopa is usually an inhibitory neurotransmitter
What is the MOA of metoclopramide?
Dopamine receptor antagonist and is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist.
What is the classic brain scan findings with Huntington's?
Enlargement of the ventricles, d/t loss of the caudate nucleus
What is the usual result of the babinski test with PD?
True or false: no response to L-DOPA is an exclusion criteria for PD