Parkinsons Disease

Question 1

Parkinson’s Disease mostly affects who?

Answer 1

Males, over 50

Question 2

Parkinsonism is an umbrella term for 3 conditions? What are they?

Answer 2

1. Parkinson’s Disease (most common)
2. Secondary Parkinsonism (Drug induced)
3. Parkinson’s-plus syndromes

Question 3

What are examples of Parkinson’s plus syndromes?

Answer 3

• MSA (Multiple system atrophy)
• PSP (Progressive Supranuclear Palsy)
• CBD (Corticobasal Degeneration)

Question 4

Parkinson’s is described to be largely idiopathic. what does this mean?

Answer 4

This means the exact cause is unknown.

Question 5

What diagnostic criteria is used to diagnose parkinson’s?

Answer 5

Parkinson’s Disease Society Brain Bank Clinical
Diagnostic Criteria
(no current “test”)

Question 6

The diagnosis is made through…

Answer 6

The individuals:
-clinical presentation
-physical examination
-medical history
(- maybe a SPECT scan)

Question 7

What are the 4 cardinal symptoms of Parkinson’s Disease?

Answer 7

• Tremor
• Rigidity
• Bradykinesia
• Postural Instability

Question 8

What are the 3 phases of PD (according to Sterne et al) ?

Answer 8

1. Pre-clinical : no clinical symptoms (but pathology assumed to be present)
2. Pre-motor : early symptoms evident
3. Motor Parkinson’s disease : manifestation of classic motor and non-motor symptoms

Question 9

What examples of premotor characteristics?

Answer 9

• Olfactory (smell) deficit
• Sleep disorders
• Constipation
• Mood changes

Question 10

By the time of diagnosis, there is typically a 70-80% reduction in the production of what neurotrasmitter?

Answer 10

Dopamine.

Question 11

What are some of the roles of the Basal Ganglia?

Answer 11

• Motor control
• Learning
• Cognitive functions
• Emotions

Question 12

What are the three Basal Ganglia circuits?

Answer 12

1. Motor Circuit (Putamen/ learning)
2. Associative Circuit (Caudate/ eye movements,
   cognitive funcitoning)
3. Limbic Circuit (Ventral Striatum/ Emotions)

Question 13

When there is a reduction in Dopmaine, what happens in the indirect and direct pathways?

Answer 13

In the direct pathways, there is a reduction in activation (turning down of “GO”)
In the indirect pathway, there is an increase in inhibition (turning up of “No Go”)

Question 14

What medical management is there for Parkinson’s?

Answer 14

Dopamine Agonists (mimics dopamine) 
• e.g. Ropinirole

Levodopa (replaces dopamine)
• e.g. Sinemet

Enzyme Inhibitors (preserve existing dopamine) 
• Prevent breakdown of dopamine
• e.g. MAO-B inhibitor

Question 15

How do dopamine agonists work?

Answer 15

They mimic dopamine

Question 16

How does Levodopa work?

Answer 16

They replace dopamine.

Question 17

How do enzyme inhibitors work?

Answer 17

They preserve existing dopamine

Question 18

What are some side effects of the medication?

Answer 18

-Hallucinations
-Levodopa induced dykinesias
(choreic movements and dystonic movements)

Question 19

What are Choreic and Dystonic movements?

Answer 19

Both involuntary
Choreic movements are abnormal, purposeless movements.
Dystonic movements are sustained muscle tightness contractions.

Question 20

What surgery option is there if medication isn’t working?

Answer 20

• deep brain stimulation

• Electrodes placed in specific brain area
are connected to a pulse generator
• Electrical impulses sent to the brain
when generator turned on
• Bilateral or Unilateral

Question 21

Why might an SLT be involved?

Answer 21

speech problems: dysarthria
language problems
cognitive problems
Dysphagia