parkinsons Flashcards

(29 cards)

1
Q

parkinsons

A

progressive reduction of dopamine in the basal ganglia - leading to disorders of movement

-> loss of dopaminergic neurons froms the pars compacta region of substantia nigra
(can see this in brain (coloured) as releases melanin)

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2
Q

types of parkinsons

A

idiopathic
familial
other (non-degenerative)
- drug induced
- post-encephalic
- toxins
- trauma

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3
Q

risk factors for parkinsons

A

advancing age - greatest
fam history (esp early onset <40yrs)
males
environmental - pesticide exposure, prior head injury, RUral living, beta blocker use

genetic
- LRRK2 (AD)
- PARKIN
- Alpha-synuclein - AD, Lewy bodies

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4
Q

what harmful act can DECREASE risk of parkinsons?

A

smoking

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5
Q

basal ganglia

A

is responsible for coordinating habitual movements – walking, looking around
o Controlling voluntary movements + learning specific movement patterns

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6
Q

substantia nigra

A

produces neurotransmitter called dopamine

-> Dopamine is essential for correct functioning of the basal ganglia

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7
Q

pathophysio of parkinsons

A

reactive gliosis happens in response to dopaminergic neuron loss -> astrocyte formation

starts at brain stem + ascends up to brain
- advanced = cortical involvement
- pre-motor symptoms = just brain

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8
Q

what would be seen if mid brain was cut into sections in Parkinsons and substantia nigra visible

A

reveal loss of normal black pigment in substantia nigra + locus ceruleus (melanin reduction)

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9
Q

parkinsons triad

A

bradykinesia - slow + diminshing movements

rigidity - increased muscle tone, resistance to passive movement, “cogwheel” as you passively flex arm (gives way to small little jerks)

tremor - at rest, unilateral pill rolling

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10
Q

parkinsons motor features

A

handwriting getting smaller, shuffling gait
difficulty initiating movements - standing still to walking
diffuculty turning - having to take lots of wee steps
reduced facial movement/expressions = hypomimia

tremor worse at rest + if distracted, 4-6Hz (4-6 times a second)

reduced arm swinging
stooped posture, forward tilt
eyes move horizontally v slowly

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11
Q

non-motor symptoms of parkinsons

A

anosmia
REM sleep disorder behaviour - act out dreams, speak, move
depression, constipation

friendly hallucinations

dementia - must have parkinsons for at least 1yr prior to onset, presentation similar to DLB

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12
Q

parkinsons diagnostic criteria

A

UK PDS brain bank criteria

  1. Bradykinesia + at least one of –
    a. Muscle rigidity
    b. 4-6hz rest tremor
    c. Postural instability not causes alternate primary cause
  2. Exclusion
    a. History of stroke
  3. Supporting criteria – 3 or more
    a. Unilateral onset
    b. Rest tremor
    c. Progressive syndrome
    d. Asymmetry
    e. Excellent response to L-dopa
    f. Development of L-dopa dyskinesia
    g. Sustained L-dopa response > 5yrs
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13
Q

what can be said about tremor dominant parkinsons

A

tremor-dominant subtype being associated with slower rate of progression and less functional disability

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14
Q

neurohistological hallmark of parkinsons

A

Lewy Bodies

(pigment loss correlates with dopaminergic loss)

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15
Q

imaging for parkinsons

A

SPECT/DaT scan

normal = comma shaped
abnormal = “period” shaped

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16
Q

key medications for parkinsons

A

levodopa (with Peripheral decarboxylase inhibitors – carbidopa / benserazide)

dopamine agonists - bromocriptine, pergolide, cabergoline

SSRIs for depression
Osmotic laxatives for constipation

16
Q

key medications for parkinsons

A

levodopa (with Peripheral decarboxylase inhibitors – carbidopa / benserazide)

dopamine agonists - bromocriptine, pergolide, cabergoline

SSRIs for depression
Osmotic laxatives for constipation

17
Q

key medications for parkinsons

A

levodopa (with Peripheral decarboxylase inhibitors – carbidopa / benserazide)

dopamine agonists - bromocriptine, pergolide, cabergoline

SSRIs for depression
Osmotic laxatives for constipation

18
Q

levodopa

A

Synthetic dopamine to boost dopamine levels

Usually combined with drug that stops it being broken down before reaches brain
* Peripheral decarboxylase inhibitors – carbidopa / benserazide

Most effective Mx for symptoms but becomes less effective over time

19
Q

side effects of levodopa

A
  • Postural hypotension – give midodrine if bad
  • Dry mouth, anorexia, palpitations
  • End of dose wearing off – worse symptoms at end of dosage interval
  • Greatest symptomatic benefit but longterm is assoc with motor complications
  • When dose too high, can develop dyskinesias (abnormal movement assoc with excessive motor activity) examples –
    o Dystonia – where excessive muscle contraction leads to abnormal postures or exaggerated movements
    o Chorea – abnormal involuntary movements that can be jerking + random
    o Athetosis – involuntary twisting or writhing movements usually in fingers, hands or feet
20
Q

side effects of levodopa

A
  • Postural hypotension – give midodrine if bad
  • Dry mouth, anorexia, palpitations
  • End of dose wearing off – worse symptoms at end of dosage interval
  • Greatest symptomatic benefit but longterm is assoc with motor complications
  • When dose too high, can develop dyskinesias (abnormal movement assoc with excessive motor activity) examples –
    o Dystonia – where excessive muscle contraction leads to abnormal postures or exaggerated movements
    o Chorea – abnormal involuntary movements that can be jerking + random
    o Athetosis – involuntary twisting or writhing movements usually in fingers, hands or feet
21
Q

4 main parkinson plus syndromes

A

progressive supranuclear palsy
multiple system atrophy
cortico-basal degeneration
Lewy body dementia

all present with parkinsonism (resting tremor, rigitidy + bradykinesia) plus additional symptoms

22
Q

progressive supranuclear palsy

A

parkinsonism + vertical gaze palsy - dysfunction of muslce involved in looking upwards

impairment of vertical gaze - down worse than up
-> may complain of difficulty reading or descending stairs

bradykinesia prominent - broadbased stiff gait, falls

tend to present with a more symmetric + tremor negative parkinsonism

23
Q

multiple system atrophy

A

rare condition where neurons of multiple system in brain degenerate
affects basal ganglia + other areas
- degen of basal ganglia -> parkinsonism
- degen in others -> autonomic + cerebellar dysfunction

autonomic dysfunction
- postural hypotension, constipation
- sexual dysfunction, abnormal sweating

cerebellar dysfucntion -> ataxia

24
cortico-basal degeneration
parkinsonism plus spontaneous activity by an affected limb, or akinetic rigidity of that limb - "alien hand syndrome" * Patients sometimes present with apraxia - the inability to conceptulise movement i.e. description of not being able to follow instructions, but being able to do them automatically
25
Lewy body dementia
progressive/FLUCTUATING cognitive decline with assoc symptoms of visual hallucinations, delusions, disorders of REM sleep typically occurs before parkinsonism, but usually both features occur within a year of each other. This is in contrast to Parkinson's disease, where the motor symptoms typically present at least one year before cognitive symptoms
26
drug induced parkinsonism
dopamine-blocking or depleting drugs, esp neuroleptics (except clozapine), induce parkinsonism or worsen symtpoms antimuscarinic drugs reduce these symptoms, although tardive dyskinesia may be made worse
27
Wilsons disease
autosomal recessive, characterised by excessive copper deposition in tissues, younger onset 10-25yrs (<50y/o) hepatitis basal ganglia degeneration speech, psychiatric problems chorea, dementia, parkinsonism blue nails Kayser-Fleischer rings - green/brown ring round iris
28
management of Wilsons
penicillamine