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8 Cards in this Set
- Front
- Back
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What motor symptoms should be asked about on history when evaluating for PD? |
Tremor at rest, slowness, stiffness, decreased volume of speech, smaller handwriting, drooling or excessive saliva, difficulty turning over in bed, changes in gait (smaller steps, freezing). |
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What is the pathophysiology of PD? |
Loss of dopaminergic neurons in the substantia nigra and the presence of Lewy bodies in the remaining dopaminergic neurons. The reduction in dopamine leads to motor symptoms. Eventually non-dopamine areas of the brain are affected. |
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What are some non-motor symptoms of PD? |
Fatigue, anxiety, leg pain, insomnia, urgency and nocturia, drooling of saliva, and difficulty maintaining concentration. |
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What steps are needed in the physical exam for PD? |
General: flat face, resting hand tremor of 4-6 beats/sec Rigidity: move the patients arm passively atthe wrist and elbow. Cogwheel rigidity is racket-like, jerking resistance to movement; lead-pipe rigidity is smooth resistance through the range of motion. also ask the patient to stand from a chair without using their arms. Gait and balance: Timed up and go test, watching for step length, arm swing, number of steps needed to turn around, and hand tremor during walking. A time> 11.5 sec indicates risk of fall. Bradykinesia: rapid alternating movements in hands and feet (tap heel and toe alternating) |
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What investigations should be considered when evaluating for PD? |
Imaging has limited usefulness as it cannot distinguish between PD and non- PD parkinsonism. Same for lab results. Testing should be done based on your differential diagnosis. |
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What features suggest a non-PD cause of parkinsonism? |
Falls at presentation or early in disease course; poor clinical response to levodopa; lack of tremor; rapid progression of syndrome (stage 3 in 3 years); symmetry at onset; prominent dysautonomia (urinary incontinence, fecal incontinence, urinary retention, persistent erectile failure, orthostatic hypotension) |
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What drugs can cause parkinsonism? |
Typical antipsychotics: haloperidol, prochlorperazine, fluphenazine, flupentixol, pimozide Atypical antipsychotics: risperidone, olanzapine, ziprasidone, aripiprazole Dopamine depletors: Tetrabenazine (used for hyperkinetic movement disorders) Antiemetics: metoclopramide Calcium channel blockers: flunarizine The following meds may rarely cause parkinsonism: Mood stabilizers: lithium Antidepressants: citalopram, fluoxetine, paroxetine, sertraline, phenylzine, moclobemide Antiepileptics: valproic acid, phenytoin Antiemetics: domperidone Calcium channel blockers: diltiazem, verapamil Antiarrhythmics: amiodarone |
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What is the approach to treatment of PD? |
There is no consensus on when to start treatment. Risks of therapy include dyskinesia and motor fluctuations, which may not be worth it for mild cases. Treatment should be tailored to the individual. Medications are used to treat symptoms. There is no evidence that therapy |
