Parkinsons Symposia

Question 1

Risk factors for parkinson’s disease?

Answer 1

Age
Male
Caucasians
Pesticides- damage to basal ganglia?
FH

Question 2

Protective factors for Parkinson’s disease?

Answer 2

Smoking

Caffeine

Question 3

Bradykinesia

Answer 3

Slowness of movement

Question 4

Parkinsonism

Answer 4

Clinical syndrome comprosisng bradykinesia and at least one of:
Tremor
Rigidity
Postural Instability

Question 5

Biggest cause of parkinsonism

Answer 5

Parkinson’s disease

Question 6

Pathological hallmarks of parkinson’s disease

Answer 6

• Neuronal degeneration in the basal ganglia

- Lewy bodies (contain proteins that accumulate)

Question 7

Clinical differential of Parkinson’s disease compared to parkinsonism

Answer 7

In addition to parkinsonism signs;
Asymmetrical features
Sustained response to levodopa (medication)

Question 8

Causes of parkinsonism

Answer 8

Parkinson's disease (and other neurodegenerative conditions)
Drug-induced (dopamine antagonists e.g. anti-psychotics)
Vascular disease (small stroke in basal ganglia)

Question 9

Describe the tremor in Parkinsonism

Answer 9

Rest tremor

‘pill rolling’

Question 10

Describe the rigidity in Parkinsonism

Answer 10

‘lead pipe’ rigidity- stiff all the way through the movement

‘cogwheel rigidity’-combination of tremor and rigidity

Question 11

Other clinical features of Parkinson’s Disease

Answer 11

Anosmia
REM behaviour disorder-acting out dreams
Dysphagia
Hypophonia
Depression and anxiety
Dementia

Question 12

Pathophysiology of movement and the basal ganglia

Answer 12

Dopaminergic neurons degenerate. Less dopamine=abnormal movement

Question 13

What scan identifies a neurodegenerative condition?

Answer 13

DaTscan
‘full stop’ in parkinson’s.
‘comma’ in normal brain

Question 14

Drugs to treat parkinson’s disease

Answer 14

Dopamine agonist
L-Dopa (precursor of dopamine)
COMT/MAO inhibitors (stop the breakdown of dopamine)

Question 15

Adverse effects of giving too much dopaminergic stimulation

Answer 15

Dyskinesia
Confusion
Hallucinations
Impulse control disorders

Question 16

Therapeutic window

Answer 16

‘on’ i.e. when symptoms of PD are suppressed or dyskinesia
‘off’ bradykinesia
Therapeutic window is narrower as the disease progresses

Question 17

Adverse effects of continuous dopinergic stimulation

Answer 17

Unpredictable fluctuations between ‘on and ‘off’

Question 18

3 main advance treatments for PD aim to narrow out therapeutic window

Answer 18

Apomorphine- dopamine agonist
Duodopa
Deep brain stimulation