Parkinson’s disease summary,Notes and [mnemonics]

Some Facts:

Parkinson’s disease 

• degeneration of dopaminergic neurons in the substantia nigra pars compacta associated with Lewy bodies, causes reduced striatal dopamine levels
• 3 cardinal signs : resting tremor, rigidity and bradykinesia
  – 2 of 3 including bradykinesia are required to make a clinical diagnosis

Medical Therapy of Parkinson’s disease PD

1. Levodopa
– for older patient
– The risk of disease acceleration and motor fluctuations & dyskinesia
2. Dopamine agonist (ropinirole, pramipexole)
– for younger patients
– used as monotherapy to delay starting L-dopa in early stage of Parkinson’s disease

– lower risk of dyskinesia
~ COMT inhibitor (entacapone)
3. MAO-B inhibitor (selegiline)
4. anticholinergic (benzhexol) – improve tremor and sialorrhea
5. apomorphine
– DaT (dopamine transporter) scan helps to differentiate Parkinson’s disease from essential tremor.
– deep brain stimulation or pallidotomy when medical therapy fails

Signs and Symptoms of Parkinson’s disease mnemonic

“SMART”

• S = Shuffling-Gait
• M = Mask-like Face
• A = Akinesia
• R = Rigidity
• T = Tremor
• 

Another Mnemonic

The motor symptoms of Parkinson Disease

A TRAP in the Park

Parkinsonism: drugs Mnemonic

SALAD:

1. Selegiline
2. Anticholinenergics (trihexyphenidyl, benzhexol, ophenadrine)
3. L-Dopa + peripheral decarboxylase inhibitor (carbidopa, benserazide)
4. Amantadine
5. Dopamine postsynaptic receptor agonists (bromocriptine, lisuride, pergolide, pramipexole)