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Questions and Answers
What is the primary reason behind motor fluctuations in patients with moderate Parkinson's disease?
What is the primary goal of management strategies for moderate Parkinson's disease?
Which of the following medications is used to treat sudden 'off' periods in patients with moderate Parkinson's disease?
What is the purpose of adding carbidopa to a patient's medication regimen in moderate Parkinson's disease?
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Which of the following is NOT a pharmacological treatment for dyskinesias in moderate Parkinson's disease?
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What is the target of Deep Brain Stimulation (DBS) in the treatment of Parkinson's disease?
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What is the primary mechanism of action of Carbidopa in Levodopa therapy?
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Which of the following Dopamine Agonists is available in a sublingual form?
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What is the primary benefit of adding Entacapone to Levodopa therapy?
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What is the recommended diet for patients with Parkinson's disease?
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What is the primary benefit of exercise in patients with Parkinson's disease?
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Which of the following medications is often used as a first-line agent in early Parkinson's disease?
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What is the primary risk of rapid titration of Levodopa therapy?
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What is the primary benefit of using Rytary, an extended-release formulation of Levodopa?
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Which of the following is a common side effect of Dopamine Agonist therapy?
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What is the primary benefit of using Opicapone, a COMT inhibitor?
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What is the primary purpose of DAT-SPECT in the diagnosis of Parkinsonian syndrome?
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What is the characteristic of a patient's response to levodopa that is considered supportive prospective positive criteria for Parkinson's disease?
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Which of the following medications is NOT a typical cause of secondary parkinsonism?
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What is the primary use of the United Parkinson's Disease Rating Scale?
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In which of the following scenarios is a referral to a Movement Disorders specialist MOST likely to be considered?
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What is the primary characteristic of the Hoehn & Yahr Scale?
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Study Notes
Motor Fluctuations and Dyskinesias
- Patients experience fluctuations between "ON" (good symptom control) and "OFF" (poor symptom control), affecting both motor and non-motor symptoms.
- Fluctuations are closely tied to medication dosing, can be predictable or sudden.
- Dyskinesias refer to involuntary movements resulting from high dopamine levels and are common side effects of Parkinson’s disease (PD) treatments.
- Dyskinesias can lead to exhaustion, weight loss, and social embarrassment; most patients prefer these over being “frozen.”
Management Strategies for Moderate Disease
- Management involves balancing motor control and addressing complications, often becoming a challenging process.
- Non-motor symptoms require attention alongside motor treatment.
- First steps may include reducing dopaminergic medications and considering non-pharmacological management for adverse effects.
- Pharmacological options for motor fluctuations include COMT inhibitors (Comtan, Opicapone) or changing levodopa formulations.
Treatment Options for Non-Motor Symptoms
- Multiple targeted treatments exist for non-motor symptoms:
- Depression: treated with antidepressants and psychotherapy.
- Anxiety: managed with SSRIs, anxiolytics, and therapy.
- Dementia: treated with cholinesterase inhibitors; medication adjustments may be necessary.
- Sleep issues: melatonin or clonazepam for REM sleep behavior disorder, focusing on sleep hygiene.
- Drooling: managed with gum, hard candy, and atropine.
Surgical and Novel Treatment Options
- Deep Brain Stimulation (DBS) targets the subthalamic nucleus (STN) or globus pallidus interna (Gpi) to improve PD symptoms.
- MRI-guided focused ultrasound is an option mainly for tremor-predominant PD.
- Duopa, a levodopa gel infusion via PEG-J tube, provides continuous medication delivery.
Advanced Disease Management
- Advanced PD management requires continually balancing motor control with non-motor and treatment-related complications.
- Approximately 30-40% of patients experience anxiety linked to motor fluctuations.
- Cognitive decline occurs in all patients, with full dementia progressions seen in 20%.
Pharmacological Therapy
- Carbidopa/levodopa (Sinemet) is the gold standard, converting to dopamine in the brain while reducing nausea.
- Variants include Sinemet IR and CR, Parcopa (dissolvable), and Stalevo (with Entacapone).
- Entacapone enhances levodopa effectiveness and is included in combination pills like Stalevo.
- Common dopaminergic therapies also include Requip, Mirapex, and Neupro patches.
Side Effects and Considerations
- Common side effects of dopaminergic therapies include nausea, excessive fatigue, visual hallucinations, and impulsivity issues.
- Medication regimens need to be individualized, with gradual adjustments to mitigate risks of neuroleptic malignant syndrome.
Diagnostic Criteria for Parkinsonian Syndrome
- Diagnosed by bradykinesia and at least one additional symptom: rigidity, rest tremor, or postural instability.
- Exclude other conditions before confirming PD diagnosis.
Differential Diagnoses
- Secondary parkinsonism can result from certain medications, vascular issues, or other neurological conditions.
- Atypical parkinsonism includes conditions like Progressive Supranuclear Palsy and Corticobasal Degeneration.
Assessment Tools
- United Parkinson’s Disease Rating Scale evaluates motor and non-motor symptoms.
- DAT-SPECT imaging visualizes dopamine transporters to help differentiate PD from other parkinsonisms.
- Hoehn & Yahr Scale indicates stages of PD severity.
Cardinal Motor Symptoms
- Cardinal symptoms of PD, often summarized as TRAP:
- Tremor: experienced in about 70% of cases as an initial symptom.
- Rigidity
- Akinesia/Bradykinesia
- Postural Instability
- Not all PD patients present with tremors, highlighting variability in symptom expression.
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Description
This quiz covers the non-motor symptoms of Parkinson's disease, including anxiety, cognitive disorders, and dementia syndrome. It also discusses the importance of ruling out underlying metabolic abnormalities and medications that may contribute to cognitive changes. Test your knowledge of these critical aspects of PD management.
