Parkinson's Parkinson's Sleep and Autonomic Function 2 — Questions and Answers
Question 1: What is typically the recommended first-line management step for orthostatic hypotension in Parkinson's disease?
- Prescribing midodrine immediately
- Increasing dietary salt and fluid intake (Correct answer)
- Starting fludrocortisone
- Prescribing compression stockings as the only measure
Correct answer: Increasing dietary salt and fluid intake
Non-pharmacological measures — especially increased salt (2–3 g/day) and fluid intake — are the first-line approach before adding medications for orthostatic hypotension in PD.
Question 2: Constipation in Parkinson's disease results primarily from which mechanism?
- Voluntary dietary restriction of fiber
- Excessive calcium supplementation blocking GI motility
- Alpha-synuclein deposits disrupting the enteric nervous system (Correct answer)
- Antibiotic overuse altering the gut microbiome
Correct answer: Alpha-synuclein deposits disrupting the enteric nervous system
Alpha-synuclein accumulation in the enteric nervous system (the gut's own nerve network) impairs bowel motility, causing constipation that is common and often an early feature of PD.
Question 3: Drooling (sialorrhea) in Parkinson's disease is primarily caused by which mechanism?
- Overproduction of saliva by the salivary glands
- Increased parasympathetic tone stimulating salivary glands
- Reduced swallowing frequency due to oropharyngeal motor impairment (Correct answer)
- Parotid gland enlargement caused by dopamine deficiency
Correct answer: Reduced swallowing frequency due to oropharyngeal motor impairment
PD does not increase saliva production; rather, impaired voluntary swallowing means saliva pools in the mouth and spills over, causing drooling.
Question 4: Urinary urgency and frequency in Parkinson's disease most commonly result from which bladder dysfunction?
- Renal disease secondary to PD
- Urethral sphincter weakness causing leakage
- Detrusor overactivity (overactive bladder) (Correct answer)
- Prostatic enlargement uniquely caused by PD
Correct answer: Detrusor overactivity (overactive bladder)
Loss of dopaminergic inhibition of the micturition reflex leads to detrusor overactivity — involuntary bladder contractions that drive urgency and frequency in PD.
Question 5: Midodrine treats orthostatic hypotension in Parkinson's disease through which pharmacological mechanism?
- Increasing central dopamine production
- Blocking beta receptors in the heart to raise BP
- Reducing heart rate to increase cardiac output
- Activating alpha-1 adrenergic receptors to cause vasoconstriction (Correct answer)
Correct answer: Activating alpha-1 adrenergic receptors to cause vasoconstriction
Midodrine is a selective alpha-1 agonist that constricts peripheral blood vessels, raising standing blood pressure and relieving orthostatic hypotension.
Question 6: Which skin condition occurs significantly more frequently in Parkinson's disease patients compared to the general population?
- Psoriasis
- Seborrheic dermatitis (Correct answer)
- Rosacea
- Atopic eczema
Correct answer: Seborrheic dermatitis
Seborrheic dermatitis — oily, scaly, inflamed skin particularly on the face and scalp — is substantially more prevalent in PD, linked to autonomic and sebaceous gland dysfunction.
Question 7: What sweating abnormality pattern is most characteristic of autonomic dysfunction in Parkinson's disease?
- Complete inability to sweat anywhere on the body
- Excessive sweating confined to the extremities only
- Hyperhidrosis of the trunk and head with reduced sweating of the extremities (Correct answer)
- Chronic hypothermia with no changes in sweating patterns
Correct answer: Hyperhidrosis of the trunk and head with reduced sweating of the extremities
A characteristic PD pattern is hyperhidrosis (excessive sweating) of the trunk and head — often at night or with medication peaks — alongside anhidrosis of the limbs.
Parkinson's Parkinson's Sleep and Autonomic Function 2
What is typically the recommended first-line management step for orthostatic hypotension in Parkinson's disease?