28. Diagnosis of parkinsons disease

Question 1

What are the diagnosis of Parkinsons disease based on?

Answer 1

Clinical diagnosis based on two basic motor symptoms at first investigation. Then it’s confirmed by histopathology.

Question 2

Early motor symptoms in Parkinsons disease

Answer 2

Bradykinesia, resting tremor, rigidity, micrography, hypomimia, posture

Question 3

Late motor symptoms in Parkinsons disease

Answer 3

Postural instability, freezing of gait, postural instability gait disorder, motor fluctation, dyskinesia

Question 4

What can you see on histopathology in Parkinsons disease?

Answer 4

Lewis bodies and nigrostriatal degeneration

Question 5

Prospective diagnostic criteria of Parkinsons disease

Answer 5

• Unilateral onset
• Resting tremor
• Progressive disorder
• Persistent asymmetry primary affecting the side of onset
• Excellent response to levodopa
• Severe levodopa induced chorea (dyskinesia)
• Levodopa response for > 5 years
• Clinical course of > 10 years

Question 6

What kind of symptoms are always found after motor symptoms in Parkinsons disease?

Answer 6

Non-motor symptoms

Question 7

Non-motor symptoms of Parkinsons disease

Answer 7

Early:
- loss of olfaction
- depression, panick attacks
- sleep disturbance
- impaired colour vision

Late/treatment related:
- dementia, hallucinations, psychosis
- autonomic response: obstipation, orthostatic hypotension, sexual and urinary problems, drooling

Question 8

Pharmacological diagnosis of Parkinsons disease

Answer 8

Levodopa challange test. Result positive if administration of levodopa relieves symptoms. alternatively use apomorphine

Question 9

Diagnostic imaging for Parkinsons disease

Answer 9

MRI. Not currently required for diagnosis, but consider in atypical presentation.