Parkinson's Disease Flashcards
(45 cards)
How is Parkinson’s diagnosed?
Bradykinesia +1 of: - 4-6 Hz tremor - Mucular rigidity - Postural instability ASSYMETRICAL
If these symptoms are bilateral, how does this change the diagnosis?
More likely to be SECONDARY PARKINSONISM caused by drugs (e.g. neuroleptics, antiemetics), CVD, infections etc
Name some non-motor symptoms of parkinson
- REM behaviour disorder (acting out dreams) and other sleep disorders - Reduction in olfactory function (ANOSMIA IN 90%!!!!) - Depression/anxiety/hallucinations - Parasthesia - Fatigue - Sexual dysfunction - Bladder dysfunction
If you see a patient with rapid onset parkinsonism and dementia, what is the most likely diagnosis?
Lewy Body Dementia
What is Parkinson’s Disease?
A progressive neurodegenerative disease with two main features: 1. Loss of pigmented dopaminergic neurons in the substantia nigra 2. Increase in Lewy Bodies
Name some other relevant motor features of PD
Dysphagia Dysarthria Hypersalivation Blurred vision Micrographia Dystonia Stooped posture Shuffling gate Freezing Festinant FALLS
What does festinant mean?
Having short stride and quickened gait
What is a parkinson plus syndrome?
A group of syndromes that exhibit the same symptoms as parkinsons but with additional features: - Multiple system atrophy - Corticobasal degeneration - Progressive supranuclear palsy
What are the typical pre-motor symptoms?
- Impaired olfaction - REM behaviour disorder - Depression - Constipation
What imaging technique is used in parkinson diagnosis?
SPECT - measures loflupane (DaTSCAN) uptake in presynaptic dopamine transporters
What does a DaTSCAN look like in a PD patient?
More like .. than the usual “
What are the pros and cons of DaTSCANS?
PRO - high sensitivity and specificity CON - expensive
Describe the onset and progression of PD
Insidious onset (latent period can be up to 3 decades) Long clinical course (10-30 years) Incurable, decreased life expectancy
What are the four stages in the McMahon model of PD?
Diagnosis (1.6 years) Maintenance (5.9 years) Complex (4.9 years) Palliative (2.2 years)
Name the 7 classes of drugs used to treat PD?
- L-dopa - Dopamine agonists - MAOB inhibitors - COMPT inhibitors - Amantadine - Anticholinergics - Oestrogen
Name two examples of L-Dopa with decarboxylase inhibitor
Madopar, Sinemet
Name two examples of MAOB inhibitors
Selegiline, Rasagiline
Name three examples of dopamine agonists
Ropinirole, Pramipexole, Rotigotine
How do L-Dopa and decarboxylase inhibitors work?
L-dopa is converted to dopamine in the brain
How do COMT inhibitors work, and what is an example?
Entacapone They stop L-dopa from being converted to 3-0 methydopa (must be used alongside)
How do MAOB inhibitors work?
They stop dopamine from being converted to its inactive metabolite
Which of the drug treatments is best for symptom control?
L-dopa, however it has motor complications, unlike the others
Why is L-Dopa used in older patients and dopamine agonists used in younger ones?
L-dopa is the best for symptomatic treatment but DAs are best in delaying onset of motor complications
Which members of the MDT are involved in Parkinsons care?
PD nurse specialist, physiotherapy, occupational therapy, SALT, support groups
