Parkinson's Disease Flashcards
(17 cards)
What is PD?
Loss of dopaminergic neurons in the ventral tier of the zona compactica in the substantia nigra
Where are Lewy bodies found?
Basal ganglia, brainstem, cortex
What is the triad of Parkinsonism?
Tremor, hypertonia, bradykinesia
When is tremor worse?
At rest
What is hypertonia?
Rigidity
How does bradykinesia manifest?
Slow to initiate movement, actions slow and decrease in amplitude with repetition, abnormal gait, expressionless face
How might someone with PD walk?
Shuffling, leaning forward, decreased arm swing, freezing at obstacles/doors
How often are signs worse on one side?
Always
What differential diagnoses should be excluded?
Cerebellar disease, fronto-temporal dementia
What non-pharmalogical management is available?
Deep brain stimulation, surgical ablation of overactive basal ganglia circuits
What is the main pharmalogical treatment?
Levodopa, a dopamine precursor
What is the main problem with levodopa?
Efficacy reduces over time requiring higher doses more frequently, leading to worsening side effects
What drugs can be used in early PD?
Dopamine agonists, like MAO-B inhibitors
What should you be aware of in patients on Levodopa?
Any potential malabsorption, Levodopa shouldn’t be withdrawn suddenly
What are the three steps of diagnosis?
Diagnosis of Parkinsonian syndrome, 0 exclusion criteria met, 3 or more supportive criteria met
How can the wear-off phenomenon be combated?
Take a COMT inhibitor alongside levodopa
How does Parkinson’s present?
Blank facial expressions except when smiling, extremely small handwriting, tremor at rest, rigid limbs and difficulty getting out of bed, slow walking
