Parkinson Disease

Anatomy

100

Structures that comprise the basal ganglia

caudate nucleus, putamen, globus pallidus, (sub-thalamic nucleus & substantia nigra?)

200

The main functions of the basal ganglia

Initiating movement, preventing inappropriate movement, switching between different movements

300

The pathway that is responsible for inhibiting unwanted movements

Indirect pathway

400

Structure that is disinhibited in the direct pathway, leading to stimulation of the motor cortex

Thalamus

500

Common symptoms associated with damage to the basal ganglia

dyskinesia, disorders involving involuntary movement, hyperkinesia/hypokinesia/akinesia 

Pathophysiology

100

Structure of the brain that is primarily affected in PD

Substantia nigra (pars compacta)

200

Type of neurons that undergo degeneration in PD

Dopaminergic

300

Histological structures found in neurons of patients with PD

Lewy bodies

400

Protein that comprises Lewy bodies

alpha synuclein

500

Motor loop pathway affected in PD

Both direct and indirect pathways are affected (this is why patients experience hypokinesia and tremors at the same time)

Clinical Features

100

Term used to describe typical features of PD

Parkinsonism

200

The 3 main signs (triad) of PD

bradykinesia, rigidity, resting tremor

300

Muscular rigidity that produces a ratcheted resistance to passive movement of the limbs

Cogwheel resistance

400

Neuropsychiatric symptoms associated with PD 

dementia, depression, anxiety

500

Prodromal features of PD

constipation, anosmia, sleep disturbances, mood disorders

Investigations/Treatments

100

PD can be treated with dopamine. True or False?

False (dopamine can't cross the BBB)

200

Decarboxylase inhibitor administered with levodopa

carbidopa

300

3 drug classes used to treat PD

dopamine agonists (ergot/non-ergot), MAO-B inhibitors, COMT inhibitors, NMDA antagonists, anticholinergic/muscarinic antagonists, levodopa + carbidopa

400

3 non-pharmacological treatments of PD

surgery, deep brain stimulation, focused ultrasound

500

3 red flags to look out for

• Rapid progression of gait impairment that eventually requires frequent use of a wheelchair 
• Stability of motor symptoms or signs for ≥ 5 years
• Early severe bulbar dysfunction in the first 5 years of disease (e.g., dysphonia, dysarthria, dysphagia) 
• Inspiratory dysfunction (e.g., inspiratory stridor, dyspnea) 
• Early severe autonomic dysfunction in the first 5 years of disease (e.g., orthostatic     hypotension, urinary incontinence) 
• Recurrent falls because of impaired balance in the first 3 years of disease 
• Severe dystonia in the first 10 years of disease (e.g., disproportionate anterocollis, orofacial dystonia) 
• Absence of common nonmotor symptoms in the first 5 years of disease (e.g., sleep dysfunction, autonomic dysfunction, hyposmia, neuropsychiatric symptoms) 
• Otherwise unexplained pyramidal tract signs (excluding brisk reflexes in affected limbs and isolated extensor plantar response) 
• Bilateral symmetric parkinsonism

Miscellaneous

100

Median age of onset of PD

60

200

Abnormally small or cramped handwritting

migrographia

300

A common disease risk factor that actually reduces the risk of PD

Smoking

400

3 medications that can cause secondary parkinsonism

antipsychotics, antiemetics (e.g. metoclopramide), neurotransmitter depletors, calcium channel blockers (e.g. amlodipine), valporate, lithium

500

Genetic mutations that can contribute to PD

GBA, LRRK2, PARK2, SNCA