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17 Cards in this Set
- Front
- Back
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What is Parkinson's disease? |
A movement disorder characterised by 4 features: |
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How common is Parkinson's disease? |
There are about 120, 000 cases in the UK. |
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Is PD inherited? |
Mostly no. There are a few cases of autosomal dominant inheritance of A-Synuclein genes, LRRK and PARK4, and recessive inheritence of PARKIN, PINK and DJ-1. |
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How is Parkinson's disease diagnosed? |
Presence of the 4 cardinal symptoms: Bradykinesia, resting tremor, rigidity, postural instability. Plus infectious or drug induced causes, and see if it improves in response to a test with L-Dopa. |
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What are the non-motor symptoms of PD? |
- Loss of sense of smell is very common - Depression and Anxiety - REM syndrome, restless leg syndrome, sleep disturbances - Drooling - Erectile dysfunction -Constipation -Urinary urgence -Orthostatic hypotension |
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What is the pathology of PD? |
There is loss of the dopaminergic neurons of the substantia nigra. This directly and indirectly inhibits the thalamus through the basal ganglionic-thalamocortical loop, which causes hypokinesia. |
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What is Braak staging? |
Braak proposed a model of pathological progression of PD based on Lewy body pathology. According to Braak, Lewy bodies first appear in the brainstem (m. oblongata, pontine tegmentum, olfactory bulb etc), then progress to the substantia nigra, midbrain, forebrain, then eventually cortex. |
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What are the risk factors for parkinson's disease |
-Age |
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What treatments are there? |
L-DOPA, MOAB inhibitors, DOPA decarboxylase inhibitors, dopamine agonists, deep brain stimulation |
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Why give dopa decarboxylase inhibitors? |
When L-DOPA is given, it can be broken down in the circulation by dopa decarboxylase. Co-administering Carbidopa increases the amount of L-Dopa that will cross the blood brain barrier. |
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Why give MOAB inhibitors? |
MOABs are given as a monotherapy in early PD; they inhibit breakdown of native dopamine by monoamine oxidase and can increase the time before a patient needs to start L-DOPA treatment. |
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Why wait to give L-DOPA? |
L-DOPA should be put off for as long as possible because though it's effective, its effects 'wear off' after a time and then there are no effective treatments. |
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What are the side effects of chronic L-DOPA use? |
- Dopamine dysregulation syndrome (impulse control disorder, mania, psychosis) - Dopamine-induced dyskinesia at peak L-DOPA load - Fluctuations in non-motor symptoms - Prolonged 'off' periods |
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What is deep brain stimulation? |
Insertion of a permanent and adjustable electrode into the area by the basal ganglia. Provides stimulation akin to dopamine. |
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What are the benefits of DBS? |
- May allow reduction of LDOPA so relieves side effects and dyskinesia - Is long lasting and stable - Reduces motor symptoms - Improves sleep - Improves QOL scores by ~30% - Improves ADLS |
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What are the side effects of DBS |
- Absolutely no effect on non-motor symptoms - Risk of depression, other mood disturbances like euphoria - May cause speech impairments - Obvious risks of infection, bleeding etc from surgery. |
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What treatments can be given for the non-motor symptoms? |
Depression: SSRIs. Dopamine agonists help too. Avoid TCAs because anticholinergic effects. Psychosis: Atypical antipsychotics like clozapine. Parkinsons disease dementia: Rivastigmine and donepezil Sleepiness: modafinil Erectile dysfunction: Sildenafil Constipation: macrogol |
