Parkinson's Parkinson's Complications and Comorbidities 2 — Questions and Answers
Question 1: Parkinson's disease psychosis is currently treated with which FDA-approved antipsychotic that does not worsen motor symptoms?
- Pimavanserin (Nuplazid) (Correct answer)
- Haloperidol
- Risperidone
- Olanzapine
Correct answer: Pimavanserin (Nuplazid)
Pimavanserin (Nuplazid) is the only FDA-approved treatment specifically for Parkinson's disease psychosis; it targets serotonin 5-HT2A receptors without blocking dopamine receptors, avoiding motor worsening.
Question 2: Excessive daytime sleepiness (EDS) in Parkinson's disease patients taking dopamine agonists is particularly dangerous because:
- Patients can experience sudden sleep attacks while driving (Correct answer)
- It worsens tremor severity
- It is a sign of medication overdose requiring emergency care
- It permanently damages the sleep-wake cycle
Correct answer: Patients can experience sudden sleep attacks while driving
Sudden onset sleep attacks associated with dopamine agonists in Parkinson's can occur without warning, creating a serious danger when driving or operating machinery.
Question 3: Camptocormia in Parkinson's disease refers to:
- Severe forward flexion of the trunk (Correct answer)
- Lateral trunk lean to one side
- Neck flexion causing chin-on-chest deformity
- Posterior trunk extension
Correct answer: Severe forward flexion of the trunk
Camptocormia is an abnormal posture of severe forward trunk flexion (bent forward at the waist) seen in some Parkinson's patients due to axial muscle rigidity or dystonia.
Question 4: Which medication class is contraindicated in Parkinson's patients because it can dramatically worsen motor symptoms?
- Dopamine-blocking antipsychotics (typical antipsychotics) (Correct answer)
- SSRIs
- Beta-blockers
- ACE inhibitors
Correct answer: Dopamine-blocking antipsychotics (typical antipsychotics)
Typical antipsychotics (e.g., haloperidol, metoclopramide) block dopamine receptors and can severely worsen Parkinson's motor symptoms and should be avoided.
Question 5: Rapid eye movement (REM) sleep behavior disorder (RBD) in Parkinson's patients is associated with:
- Higher risk of cognitive decline and dementia (Correct answer)
- Better medication response
- Milder disease course
- Purely motor benefits from treatment
Correct answer: Higher risk of cognitive decline and dementia
The presence of RBD in Parkinson's disease is associated with greater disease burden, faster progression, higher risk of developing dementia, and more visual hallucinations.
Question 6: Hypersalivation (sialorrhea) in Parkinson's disease results primarily from:
- Reduced frequency of automatic swallowing, not excessive saliva production (Correct answer)
- Overactive salivary glands
- Anticholinergic medication effects
- Autonomic overactivation
Correct answer: Reduced frequency of automatic swallowing, not excessive saliva production
Sialorrhea in Parkinson's is caused by reduced automatic swallowing frequency due to bradykinesia, causing saliva to accumulate and pool in the mouth, not by excessive production.
Parkinson's Parkinson's Complications and Comorbidities 2
Parkinson's disease psychosis is currently treated with which FDA-approved antipsychotic that does not worsen motor symptoms?