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

Locus coeruleus and pars compacta region of substantia nigra

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

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

Answer 5

True

Question 6

List clinical non-motor features of Parkinson’s disease

Answer 6

Olfactory dysfunction
Cognitive impairment
Psychiatric symptoms
Sleep problems
Pain and fatigue

Question 7

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

Answer 7

True

Question 8

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

Answer 8

Lewy bodies and neurites

Question 9

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

Answer 9

False

2nd most common after Alzheimer’s disease

Question 10

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

Answer 10

LRRK2 (dominant)

parkin (recessive)

Question 11

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

Answer 11

True

Question 12

Symptomatic treatment for Parkinson’s disease aims to increase dopamine concentration or stimulate dopamine receptors - what is the main drug used for this?

Answer 12

Levodopa

Question 13

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

Answer 13

Clozapine

Anticholinergics

Question 14

List side effects of levodopa and dopamine agonists

Answer 14

Nausea
Daytime somnolence
Oedema
Impulse control disorders
Hallucinations

Question 15

Levodopa is associated with dyskinesia and motor fluctuations in the long-term. True/False?

Answer 15

True

Question 16

What must levodopa be given with and why?

Answer 16

dopa-decarboxylase inhibitors (carbidopa) to prevent peripheral metabolism of levodopa

Question 17

Name other drug classes useful in Parkinson’s and give examples

Answer 17

Monoamine oxidase B inhibitors (rasagiline and selegiline)
Dopamine agonists (pramipexole)

Question 18

What is the mechanism and side effects of Monoamine oxidase B inhibitors? when are they used?

Answer 18

Inhibits monoamine oxidase B (wow) which is an enzyme that converts dopamine to homovanillic acid.
It can cause hypertensive crisis when consumed with tyramine containing food (e.g. cheese).
It can be used as add on therapy, or even monotherapy in mild parkinsons

Question 19

Name some drugs that can cause drug-induced parkinsonism

Answer 19

chlorpromazine, haloperidol, lithium, valproic acid, metoclopramide