L9 Parkinson
14 important questions on L9 Parkinson
What is Parkinson's disease?
The black center is gone
It taks place in the Substantia nigra
What are the Cardinal motor signs of Parkinson's disease?
- Slowness
- Bradykinesia
- Decrease in amplitude
- Fatigueing
- Also: hypomimia, decreased armswing, micrographia
- Rigidity
- you can feel the rigidity
- Tremor
- only in 60% of patients
- typically asymmetrical and in rest
- socially limiting
- Postural abnormalities
What are the non-motor symptoms of Parkinson's disease?
- Neuropsychiatric
- Cognitive dysfunction
- Depression/apathy
- Hallucinations/psychosis
- Sleep
- RBD
- Autonomous
- Orthostatic hypotension
- Urinary problems
- Gastro-intestinal
- Swallowing
- Delayed gastric emptying
- Constipation
- Sensory
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What is the importance of non-motor symptoms?
- Frequent
- Can precede motor symptoms
- Correlate with Quality of Life
- Often non-dopaminergic
- Hard to treat
Name some triggers for Parkinson's disease
- Gastrointestinal microbiota perturbations
- Pathogens
- Air pollution
- Pesticides
- Heavy metals
- Head trauma
Name some facilitators for Parkinson's disease
- Inflammation --> cytokines, > with IBD, < with TNF-alfa blokkers
- Mitochondrial dysfunction
- Genetic factors 10-15% of PD
Name some aggravators for Parkinson's disease
- Impaired autofagy
- neuro-inflammation
What is the relevance to disease modification?
What is the main treatment for Parkinson's disease?
- Dopamine precursor
- Fixed combination with decarboxylase-inhibitor
- Available since 1969, still most effective treatment with the least side-effects
- Effective until late in the disease, but loss of predictability of effect
An other treatment is dopamine agonists, what do they do?
- Less effective than levodopa
- More side effects (impuls control disorders!)
- Delay response fluctuations
- May be considered in young-onset PD
Name some advanced treatments for parkinson's disease
- DUODOPA pomp
- a gel that wil go directly in your duodenum
- Apomorphine
- inject (--> but can cause skin damage)
- Deep brain stimulation
- a electrode in your brain, that gives electrical stimulations
What is the interaction guideline for Levodopa?
- Levodopa >30 mins before or 60 mins after meal
- Consider decreasing protein to 0.8g/kg body weight
- Consider protein redistribution diet
People who are taking Levodopa can also get... And are asked to ...
Weight loss
- Weigh monthly
- Refer to dietician when loss > 5% in 1 month or > 10% in 6 months
- If it bothers you than do not take the Levodopa
- Drink 1.5-2 liters per day
- Excersise
- Fruit & fibers
- more needs to be taken
- Vit D is decreased
- Osteoporosis risk
- Treat women >50, men >70
- They have a decreased intake
- Role in levodopa degradation
- check with symptoms
- Monitor strictly with Duodopa
Ongoing research about Parkinson's disease?
- Diet and microbioma
- Insulin resistance?
- type 2 diabetes is risk factor
- faster progression
- central insulin resistance
- potential role for GLP-1 agonists
- Milk (pesticides in milk)
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