Parkinson's Disease

Question 1

What is Parkinson’s disease?

Answer 1

Neurodegenerative disease that arises due to dopaminergic neurone loss in the brain

Question 2

Which part of the brain does dopaminergic loss occur in Parkinson’s disease?

Answer 2

Substantia nigra pars compacta

Question 3

Is Parkinson’s disease typically a cerebellar, pyramidal tract or extra-pyramidal tract problem?

Answer 3

Extra-pyramidal

Question 4

List the triad of the “Parkinsonian syndrome”

Answer 4

Rigidity
Bradykinesia
Resting tremor

Question 5

List clinical motor features of Parkinson’s disease

Answer 5

Resting tremor
Muscle rigidity +/- cogwheeling
Bradykinesia
Gait
Postural impairment

Question 6

Tremor-dependent Parkinson’s disease carries better prognosis than tremor-independent Parkinson’s disease. True/False?

Answer 6

True

Question 7

List clinical non-motor features of Parkinson’s disease

Answer 7

Olfactory dysfunction
Cognitive impairment
Psychiatric symptoms - hallucinations
GI dysfunction
Depression
Sleep problems
Pain and fatigue

Question 8

Diagnosis of Parkinson’s disease occurs with the onset of motor symptoms. True/False?

Answer 8

True

Question 9

What is the pathological name given to the mis-folded protein aggregates that accumulate in the brain to cause Parkinson’s disease?

Answer 9

Lewy bodies and neurites

Question 10

Parkinson’s disease is the most common neurodegenerative disease. True/False?

Answer 10

False

2nd most common after Alzheimer’s disease

Question 11

Which gene mutations are the most common causes of dominant and recessive Parkinson’s disease respectfully?

Answer 11

LRRK2 (dominant)

Parkin (recessive)

Question 12

There are no neuroprotective/disease-modifying drugs for Parkinson’s disease. True/False?

Answer 12

True

Question 13

List some drugs that can be used for symptomatic treatment of Parkinson’s?

Answer 13

LEVODOPA
Dopamine agonists e.g. Selegelline
Monoamine oxydase type B inhibitors
Amantodine
Tolcapone

Question 14

Which agents can be useful for tremor in Parkinson’s disease?

Answer 14

Clozapine

Anticholinergics

Question 15

List side effects of levodopa and dopamine agonists

Answer 15

Nausea
Daytime somnolence
Oedema

Question 16

When do motor features appear during the coarse of Parkinson’s?

Answer 16

In late Parkinson’s Disease

After 60-80% of dopamine cells are dead

Question 17

Which sign on imaging would suggest a diagnosis of Parkinson’s Disease?

Answer 17

Dark black pigment loss (loss of substantia niagra)

Question 18

What is the action of drugs used in Parkinson’s Disease?

Answer 18

Increase dopamine concn or stimulate dopamine receptors.

Question 19

Parkinson’s is a selective neurogenic disease. True/ False?

Answer 19

False

Variety of neurotransmitters affected, including dopamine, noradrenaline, acetylcholine, serotonin

Question 20

What is typically the first clinical sign to appear in Parkinson’s Disease?

Answer 20

Non-motor sign: GI dysfunction

Question 21

What are the main subtypes of Parkinson’s Disease?

Answer 21

Tremor dominant (absence of other motor symptoms)
Non-tremor dominant (akinetic rigidity + postural instability)
Mixed/ indeterminate

Question 22

Which diagnostic tests may be helpful in Parkinson’s disease?

Answer 22

Structural brain imaging (view basal ganglia)

SPECT (DaTSCAN)

Question 23

Which symptoms in a patient would make a diagnosis of Parkinson’s Disease less likely?

Answer 23

Early onset bulbar problems
Early dementia and hallucinations
Eye movement disorder
Intrusive early autonomic problems

Question 24

What is classed as ‘Parkinsonism’?

Answer 24

Bradykinesia and 1 of following:
Resting tremor
Rigidity (cog-wheel or lead pipe)
Postural instability

Question 25

List the risk factors of Parkinson's Disease

Answer 25

``` Increasing age Family history Male Environmental factors Genetics ```

Question 26

Drugs used to manage Parkinson's disease are associated with what long term complications?

Answer 26

Motor fluctuations Non-motor fluctuations Dyskinesia (levodopa) Drug induced psychosis (e.g. dopamine agonists- impulse control disorders, hallucinations)

Question 27

List some non-pharmacological therapies that can be used in Parkinson's Disease?

Answer 27

Deep brain stimulation DUODOPA Continuous apomorphine infusion

Question 28

A tremor in which anatomical location is particularly suggestive of Parkinson's Disease?

Answer 28

Chin

Question 29

How would you go about eliciting a resting tremor in Parkinson's?

Answer 29

Ask the patient to count backwards from 100

Question 30

Which subset of Parkinson's involves degeneration of midbrain and vertical gaze palsy?

Answer 30

Progressive supranuclear palsy

Question 31

Which subset of Parkinson's involves orthostatic hypotension and a poor response to levodopa?

Answer 31

Multiple system atrophy

Question 32

Which drug should be used to control vomiting in Parkinson's?

Answer 32

Domperidone - dopamine agonist that doesn't cross the BBB

Question 33

Which medication should be used for a patient on Parkinson's therapy with acute psychosis?

Answer 33

Quetiapine